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Seizures and Status Epilepticus: Diagnosis and Management in the Emergency Department

August 2006


For most of human history, seizures were looked upon differently than most other medical conditions. They manifest clinically as unusual behaviors with attacks occurring suddenly in a dramatic and mysterious fashion; afterwards, patients have no recollection or explanation for what happened. Indeed, their unusual features caused many to believe that it was less of a medical problem and more of a manifestation from another world. Hippocrates, in 400 B.C., referred to it as “the sacred disease,” referring to the predominant superstitious view of the condition. Only in recent medical history has electrodiagnostic testing allowed us to understand the pathophysiologic basis of seizures, though there is still much to discover regarding etiology, clinical manifestations, and treatment.

The challenge for the emergency physician (EP) has three parts:

First, the seizure must be recognized (this is easy when it has a motor component; it’s more difficult when it has no motor component) and managed. In the case of status epilepticus, the EP must have an established protocol in place to allow for rapid control. Second, underlying life threatening conditions must be identified and treated.

Third, the future risk for having seizures must be assessed and, from the ED perspective, proper disposition and follow-up must be arranged in order to minimize potential complications.

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