Emergency Department Clinical Pathway for
Management of New Unprovoked Seizure(s)

  • FLOC/RN Assessment
Concern for Provoked Seizure
or Status Epilepticus
  • Evaluation, treatment as clinically indicated
  • Neurology Consultation
  • Evaluate for Concerning Features
    • Mental status not improving after 15 minutes from seizure cessation or ED presentation
    • Post-seizure (Todd’s) paralysis lasting > 15 minutes
    • Seizure duration > 5 minutes
    • Medication used to stop seizure
    • > 1 seizure in 24 hours
    • Focal seizure
    • Developmental regression
    • Age < 2 years
    • Anticipated difficulty with Neurology follow up
No Concerning Feature(s) Present
Concerning Feature(s) Present
  • Patient returned to baseline mental status and exam
  • Emergent Imaging and Labs not generally indicated
Discharge
Consider Discharge
Return to baseline mental status and exam
Consider Admission
Persistently altered mental status and/or abnormal neurologic exam
  • Neurology follow up within 2 weeks
  • ED Provider:
    • Orders Neurology follow-up appointment in EPIC
    • Consider rescue medication if:
      • Seizure > 5 min
      • Lives far from medical care
  • Neurology arranges:
    • EEG with appointment
    • MRI
      • Expedited within 1 week or
      • Routine within 2-4 weeks
  • Need for Urgent MRI (< 48 hrs)
    • ED places MRI order, if indicated
  • Anticipated difficulty with Neurology follow up
Posted: April 2021
Authors: L. Buchhalter, MD; M. Blackstone, MD; N. Abend, MD; P. Joshi, MD; A. Patel, CRNP; L. Wilson, RN;
M. Pinardo, RN, E. Schwartz, MD, J. Tencer, MD