Epilepsy in the Acute Medical Unit

Suspected seizures account for 3% of all ambulance service responses and are the commonest neurological reason for unplanned hospital admission. Immediate management in the hospital includes resuscitation, high-flow oxygen and intravenous access. Thiamine and glucose should be considered. If the seizure is prolonged, benzodiazepines need to be given. A detailed eyewitness account, examination, and investigation are performed to identify any potential causes of the seizure. Urgent computed tomography head imaging may be indicated, but a magnetic resonance imaging brain scan is the modality of choice. An electroencephalogram (EEG) within 24 hours has a higher yield for detecting epileptic activity than if an EEG is delayed. Anti-seizure medication is indicated after a second seizure or if there is thought to be a high risk of recurrence. First aid, lifestyle and driving advice are essential before hospital discharge.