Epileptic Seizures

First fit in an Adult
- Focused history. Full clinical examination with a thorough neurological examination to include GCS and fundoscopy.
-Document vital signs including temperature
- Check blood sugar
- Record ECG
- U&E, FBC, pregnancy test in females
-  CT if focal neurology, GCS < 15 at 1 hour, age >50yrs, HIV/ immunocompromised   
- If there is diagnostic doubt and the patient is seen within 30 minutes of seizure, take blood for prolactin level as a raised level may help to differentiate between a fit and other causes of loss of consciousness.
- If the fit was brief and a full recovery has been made, the patient can be discharged if a Neurology outpatient appointment can be arranged
- Advise NO driving until they have been seen in clinic
- Advise on lifestyle changes eg, working at heights or with machinery, unsupervised swimming etc.
-  If the patient needs admission, they should be admitted under the medical team. 
 
First fit in a Child 
- First fits should be admitted under the paediatricians.
- All febrile convulsions to be referred to paediatrics. 
- Subsequent fits. If child has made a full recovery they may be discharged but discuss with the ED senior first. Send blood for anticonvulsant levels if appropriate. 
 
KNOWN EPILEPTIC PRESENTING WITH A SINGLE FIT 
 - If the patient has made a full recovery they may be discharged
- If you suspect that non-compliance with medication was a factor in the cause of the fit, check the anticonvulsant level
- If the patient has seizures seldomly but has had two or more fits in 24 hours then they should be admitted.
- Any patient needing admission should be admitted medically. 

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