Seizure

Basic Approach * Step 1: Describe the seizure* Did patient have an aura? * Was there loss of consciousness?* What did the movements look like?* Did they have postictal phase? * Did they have a trauma as well?* Step 2: Ask about TIME (mnemonic)* Tongue biting* Usually occurs on the lateral sides of tongue* Incontinence* Medication changes/adjustments* Ethanol use* Step 3: Do a FULL neurologic examination* Mental Status* Cranial nerves* Visual fields* Speech* Cerebellar (finger-nose)* Motor* Sensation* Reflexes* Gait* Step 4: Testing plan* Glucose* Pregnancy Test* CBC* Electrolyte panel* Urine drug screen* Drug levels of anti-epileptic agents* Step 5: Simple seizures (<5 minutes) do not require immediate treatment* Roll them on side* Suction Additional Reading * Approach to Status Epilepticus (EM Clerkship)