In this section
1st Time Seizure
Updated by: Dr. Hecox
Updated on: 1/2018
Signs and symptoms - symptoms before seizures (preictal)
- Precipitating events: illness, trauma, toxins, sleep deprivation
- Preceding aura: strange smell or taste, change in vision, tingling sensation
- Behavior/ mood before and after Symptoms during seizure (ictal) Retention or loss of awareness during event
- Cry, gasp, garbled or slurred speech
- Head and eye deviation, posturing, stiffening, rhythmic jerking
- Automatisms: purposeless repetitive movements (lip smacking, picking at clothes)
- Movements or whole body or focal
- Change in breathing or cyanosis
- Drooling, pupillary dilatation, incontinence Symptoms after seizure (postictal)
- Lack of recall of event, confusion, lethargy
- Nausea or vomiting
- Muscle aches
- Transient focal weakness (Todd's paralysis)
- electrolyte disturbances infection
- toxic exposure
- acquired or genetic cause associated with an anatomic or pathologic abnormality such as developmental malformation or neurocutaneous syndromes
Referring provider's initial evaluation and management:
Diagnosis and treatment
- EEG: Regular. CHW schedulers will give pt/family instructions.
- Laboratory tests: routine lab testing is not recommended, consideration for lab tests should be based on individual clinical circumstances. May consider if indicated by clinical presentation:
- Basic serum studies- complete blood count, glucose, electrolytes, calcium, and magnesium
- Toxicology screen
- Basic metabolic evaluation if suspect a metabolic abnormality in a neonate with serum ammonia, serum lactate and pyruvate, serum amino acids, and urine organic acids.
- Lumbar puncture (LP) in patients with clinical concern for meningitis or encephalitis (< 6 mo. old, Kernig or Brudzinski sign) or altered mental status.
- Neuroimaging: consider for certain clinical circumstances such as focal neurological symptoms on examination, significant cognitive or motor impairment of unknown etiology, or seizures with partial onset
- MRI- preferred modality on non-urgent basis
- CT for emergent imaging- postictal persistent focal deficit, patient not returning to baseline, history of trauma
- EKG maybe needed in certain circumstances
When to initiate referral/ consider refer to Neurology Clinic:
- Abnormal EEG
- Second unprovoked seizure
- Focal symptoms
- Abnormal neurological examination
What can referring provider send to Neurology Clinic?
1. Using Epic
- Please complete the external referral order
In order to help triage our patients and maximize the visit, the following information would be helpful include with your referral order:
- Urgency of the referral
- What is the key question you would like answered?
Note: Our office will call to schedule the appointment with the patient.
2. Not using Epic external referral order:
- In order to help triage our patients maximize the visit time, please fax the above information to (414) 607-5288
- It would also be helpful to include:
- Chief complaint, onset, frequency
- Recent progress notes
- Labs and imaging results
- Other Diagnoses
- Office notes with medications tried/failed in the past and any lab work that may have been obtained regarding this patient's problems.
Specialist's workup will likely include: