Unprovoked Seizure Clinical Pathway — Emergency Department

History and Physical

A detailed physical exam and history is critical to clarifying the nature and prognosis of abnormal movements or altered mental status. This information is contextualized by the patient's development and baseline health status. At times, a suspected provoking cause is determined after a more detailed history and physical exam. In some cases, the diagnosis of seizure can be made or ruled out on the basis of clinical data alone.

Focused History	Event Details Prodrome Focality/laterality of limbs, head, eyes Duration of event Number of event(s) Apnea/desaturation/color change Incontinence Injury Resolved spontaneously or with medication Post-event behavior Fever, duration, temperature Other associated symptoms Hydration status Trauma history
Past Medical History	Immunizations Previous seizures: afebrile or febrile Neurologic diagnoses Developmental delay/intellectual disability Developmental regression/loss of milestones Autism spectrum disorder Behavioral health diagnoses Medications Family history of epilepsy and/or febrile seizure
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
Physical Exam Reassessments as needed	Vital signs General appearance, Mental Status Detailed neurologic exam Signs of trauma (accidental or abusive) Signs of CNS infection, sepsis

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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Unprovoked Seizure Clinical Pathway — Emergency Department

History and Physical

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Unprovoked Seizure — History and Physical — Clinical Pathway: Emergency Department

Unprovoked Seizure Clinical Pathway — Emergency Department

History and Physical