EMERGENCY SEIZURE CARE IN ADULTS WITH KNOWN EPILEPSY

We describe the prehospital and emergency department care provided to adults with known epilepsy in an attempt to determine whether such pat ients required prehospital transportation and to describe the laborato ry and radiographic studies obtained. One hundred consecutive emergenc y department visits for seizures or seizure-related problems of known epileptics were analyzed by chart review. These visits represented 75 different patients, six leading to hospital admission and 16 involving seizure-related injuries. Some tests and treatments were clearly usef ul, whereas others may have been unnecessary; computed tomography (CT) scans were performed in eight patients because of a secondary head in jury or unexplained neurological impairment. Subdural hematomas were d etected in two. Antiepileptic drug (AED) levels were measured in 24 pa tients with admitted noncompliance. Twenty-three had predictably low l evels. Twenty transports were considered potentially unnecessary by Ep ilepsy Foundation of America (EFA) guidelines (known epilepsy, conscio usness returns without further incident, no signs of injury, physical distress, or pregnancy). Only one patient required special care; she h ad a second seizure on arrival at the emergency department and was adm itted to the observation unit.