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Management of Seizures and of Epilepsy in the Emergency Department 

Management of Seizures and of Epilepsy in the Emergency Department
Management of Seizures and of Epilepsy in the Emergency Department

Andrea O. Rossetti

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date: 02 July 2022

Seizures represent a frequent challenge encountered in the emergency department (ED). This chapter begins with a review of epidemiological estimations for both pediatric and adult populations, highlighting that this problem accounts for 1-2% of all ED visits, and that its incidence varies with age, reflecting underlying etiologies. Differential diagnostic issues are then discussed, with particular emphasis on differentiation between epileptic seizures and syncope, psychogenic-non-epileptic seizures, or parasomnias, although other entities (such as migraine, movement disorders, or metabolic-toxic problems) may at times mimic seizures. Following this, an analysis of the diagnostic work-up under the light of evidence-based evaluations is provided: EEG and brain imaging are widely recommended in patients with first ever events; integrating practical considerations, a more or less extensive hematologic and biochemical work-up, as well as lumbar puncture, toxicology, or drug levels, may be additionally required in several situations. Finally, the rationale underlying institution of long-term anti-epileptic treatment is provided: this indicated for patients with a suspected diagnosis of epilepsy, and not just of ‘seizures’. Furthermore, patients should not receive benzodiazepines ‘at the scene’ after isolated seizures, since this treatment is reserved for subjects suffering from impending or manifest status epilepticus.

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