Approach to Evaluating the History of a Seizure

Key Components of Seizure History Evaluation

A thorough seizure history evaluation should gather information about potential triggers or warning signs that preceded the event, with emphasis on pre-ictal, ictal, and post-ictal phases to guide appropriate diagnostic testing and management, according to the American College of Emergency Physicians 1
Documenting any recent illness, fever, head trauma, sleep deprivation, alcohol use/withdrawal, or drug use is crucial in evaluating the seizure history, as recommended by the American College of Emergency Physicians 1, 2
The duration of the seizure activity should be recorded, as it is an important factor in determining the severity of the seizure, according to the American College of Emergency Physicians 3

A complete neurological examination, with special attention to focal deficits, should be performed to assess for any abnormalities, as recommended by the American College of Emergency Physicians 1
Checking vital signs, particularly for fever which may suggest infection, is an essential part of the physical examination, according to the American College of Emergency Physicians 1, 2
Examining for signs of intoxication or withdrawal is also important, as alcohol withdrawal can be a potential cause of seizures, as noted by the American College of Emergency Physicians 2

For otherwise healthy adults with new-onset seizure who have returned to baseline, serum glucose and sodium levels should be checked, as well as a pregnancy test for women of childbearing age, according to the American College of Emergency Physicians 1
Additional testing, such as lumbar puncture, head CT scan, and toxicology screening, may be necessary based on specific clinical scenarios, as recommended by the American College of Emergency Physicians 1, 2, 4
The American College of Emergency Physicians recommends considering higher risk factors, such as abnormal neurological examination, structural brain lesions on imaging, and abnormal EEG, when assessing the risk of recurrence 4