ACUTE NEUROLOGICAL CONDITIONS

General Medical Emergencies 91

5 Discharge home a known previous epileptic if:
(i) A rapid, full recovery is made.
(ii) The seizure lasted less than 5 min and was not associated with
trauma either before or during the seizure.
(iii) There are no residual focal CNS signs and the level of
consciousness is normal.
(iv) Their usual medication is adequate and being taken.
(v) There is an adult to accompany the patient.

6 In addition, discharge home a patient under 40 years with a non-focal first
seizure, with no serious underlying cause found (having considered the
causes listed under point 3 on p. 90), and who makes a full recovery without
focal neurology.
(i) Perform a CT head scan first, or organize one within the next day
or two.
(ii) Confirm safe discharge with the senior ED doctor.
(iii) Organize an outpatient EEG and medical clinic review.
(iv) Advise the patient not to drive, operate machinery, supervise
children swimming, or bath a baby alone etc. until seen by the
specialist. Record this advice in writing in the notes.

7 Always inform the GP by fax or letter on discharging the patient, and if the
patient was referred to the medical or neurology clinic for follow-up.

Generalized convulsive status epilepticus

DIAGNOSIS

1 Generalized convulsive, grand mal, major motor or tonic–clonic status
epilepticus is defined as two or more grand mal seizures without full recov-
ery of consciousness in between, or recurrent grand mal seizures for more
than 5–10 min.

2 Over 50% patients have no prior history of seizures.
(i) Thus it is essential to look for any of the underlying ‘acute
symptomatic’ causes listed under point 3 on page 90.
(ii) Therefore, perform all the tests mentioned under point 5 on
p. 90, once the seizures have been terminated.

3 Attach a cardiac monitor and pulse oximeter to the patient on arrival.

Warning: never diagnose new-onset ‘epilepsy’ in a non-epileptic patient

until, as a minimum, secondary causes have been excluded by a CT brain

scan, and an electroencephalogram has been performed and a specialist

outpatient assessment has occurred.

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