Written By: Chris Cochrane, FM Resident in Medicine Hat

Peer Review By: Kevin Duncan, EM Resident in Kelowna

Objective One: a) In a patient having a seizure: Ensure proper airway control (e.g., oropharyngeal airway or nasal trumpet, lateral decubitus to prevent aspiration). b) Use drugs (e.g., benzodiazepines, phenytoin) promptly to stop the seizure, even before the etiology is confirmed. c) Rule out reversible metabolic causes in a timely fashion (e.g., hypoglycemia, hypoxia, heat stroke, electrolytes abnormalities).

Objective Two: In a patient presenting with an ill-defined episode (e.g., fits, spells, turns), take a history to distinguish a seizure from other events.

Objective Three: In a patient presenting with a seizure, take an appropriate history to direct the investigation (e.g., do not over investigate; a stable known disorder may require only a drug-level measurement, while new or changing seizures may require an extensive work-up).

Objective Four: In all patients presenting with a seizure, examine carefully for focal neurologic findings.

Objective Five: In a patient with a previously known seizure disorder, who presents with a seizure or a change in the pattern of seizures: a) Assess by history the factors that may affect the primary seizure disorder (e.g., medication compliance, alcohol use, lifestyle, recent changes in medications [not just antiepileptic medications], other illnesses). b) Include other causes of seizure in the differential diagnosis. (Not all seizures are caused by epilepsy.)

Objective Six: In the ongoing care of a patient with a stable seizure disorder: a) Regularly inquire about compliance (with medication and lifestyle measures). side effects of anticonvulsant medication, and the impact of the disorder and its treatment on the patient's life (e.g., on driving, when seizures occur at work or with friends). b) Monitor for complications of the anticonvulsant medication (e.g., hematologic complications, osteoporosis). c) Modify management of other health issues taking into account the anticonvulsant medication (e.g., in prescribing antibiotics, pregnancy).