Adult Patients Presenting to the Emergency Department With Seizures

Publication Date: April 18, 2024
Last Updated: April 22, 2024

Summary of Recommendations

Emergency physicians should treat seizures refractory to appropriately dosed benzodiazepines with a second-line agent. Fosphenytoin, levetiracetam, or valproate may be used with similar efficacy. (A)
334012

Recommendation Grading

Overview

Title

Management of Adult Patients Presenting to the Emergency Department with Seizures

Authoring Organization

American College of Emergency Physicians

Publication Month/Year

April 18, 2024

Last Updated Month/Year

May 1, 2024

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

This clinical policy from the American College of Emergency Physicians addresses key issues in the evaluation and management of adult emergency department patients presenting with seizure. A writing committee conducted a systematic review of the literature to derive evidence-based recommendations to answer the following clinical question: In emergency department patients with generalized convulsive status epilepticus who continue to have seizures despite receiving optimal dosing of benzodiazepine, which agent or agents should be administered next to terminate seizures? Evidence was graded, and recommendations were made based on the strength of the available data.

Target Patient Population

Adult patients aged 18 years and older presenting to the emergency department with generalized convulsive seizures

Target Provider Population

Physicians working in emergency departments

Inclusion Criteria

Male, Female, Adolescent, Adult, Older adult

Health Care Settings

Emergency care, Medical transportation

Intended Users

Nurse, nurse practitioner, paramedic emt, physician, physician assistant

Scope

Treatment, Management

Diseases/Conditions (MeSH)

D012640 - Seizures, D004635 - Emergency Medicine, D020270 - Alcohol Withdrawal Seizures, D003294 - Seizures, Febrile, D003295 - Convulsive Therapy, D003292 - Convulsants

Keywords

seizure, adult seizure, unprovoked first seizure