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<< Seizures and Status Epilepticus: Diagnosis and Management in the Emergency Department
Disposition
Disposition from the ED must take into consideration the patient’s social situation, resources, and compliance. Patients are not ready for discharge until they have returned to their baseline mental status. Patients who have had a first time seizure but have a completely normal neurologic exam and no underlying medical problems do not usually require admission, especially if good follow-up can be provided. Known seizure patients with low AED levels are usually safe for discharge home once they have been loaded with their AED. Those with adequate AED levels and breakthrough seizures are usually safe for discharge after discussion with their physician or neurologist and a period of observation from four to six hours.
All patients who have had a seizure must be advised not to drive and to avoid placing themselves or others in potentially dangerous situations until assessed by their physician. All states have laws regulating driving and epilepsy though only six states have mandatory reporting requirements.215 If possible, family members should be instructed how to handle the patient if another seizure occurs. Emphasis should be on safe positioning; the myth of forcing an object, such as a spoon, into the patient’s mouth to keep them from “swallowing their tongue” should be explicitily addressed since such action may result in more harm than good.
All patients who have had a seizure must be advised not to drive and to avoid placing themselves or others in potentially dangerous situations until assessed by their physician. All states have laws regulating driving and epilepsy though only six states have mandatory reporting requirements.215 If possible, family members should be instructed how to handle the patient if another seizure occurs. Emphasis should be on safe positioning; the myth of forcing an object, such as a spoon, into the patient’s mouth to keep them from “swallowing their tongue” should be explicitily addressed since such action may result in more harm than good.
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