Discharge Instructions for Patients Hospitalized for Seizures

Assessment Prior to Discharge

Patients with a normal neurologic examination who have returned to their clinical baseline can be safely discharged from the hospital with appropriate outpatient follow-up, as recommended by the American College of Emergency Physicians 1, 2
Ensure patient has returned to neurological baseline with a normal mental status score, similar to a Glasgow Coma Scale (GCS) score of 15, to assess for any neurological deficits 3
Verify completion of appropriate diagnostic workup to identify underlying cause of seizures, such as laboratory tests and imaging studies, to determine the etiology of the seizure 4
Confirm that any acute intracranial processes or metabolic abnormalities have been addressed, such as treating any underlying infections or electrolyte imbalances, to prevent further complications 4
Assess risk factors for seizure recurrence, including age, substance abuse, and abnormal neuroimaging, to determine the risk of future seizures 3

Patients with a normal neurologic examination, no comorbidities, and no known structural brain disease do not need to be started on an antiepileptic drug (AED) before discharge, according to the American Academy of Neurology 1, 2, 5
For patients with remote symptomatic seizures, treatment after first seizure may be appropriate due to higher recurrence risk, as recommended by the American College of Emergency Physicians 6
Ensure therapeutic drug levels before discharge if applicable, to ensure the patient is receiving the correct dose of medication 4
Serum drug levels do not need to be rechecked before discharge, but follow-up monitoring is important, to monitor for any potential side effects or interactions 2

If neuroimaging was deferred during hospitalization, ensure reliable outpatient follow-up for this study, such as scheduling a follow-up appointment with a neurologist, to complete the diagnostic workup 4

Educate patients about seizure triggers to avoid, such as sleep deprivation, substance abuse, and recreational drugs, to reduce the risk of future seizures 2, 5

Return to emergency department for seizures lasting more than a few minutes, multiple seizures without returning to baseline between episodes, new focal neurological deficits, persistent altered mental status, fever, or signs of infection, as recommended by the American Heart Association 7, 3, 4