Immediate follow-up after a seizure

Immediate management of patients who have had a seizure depends on the patient's history and whether an acute treatable cause can be identified.

If the patient has no history of previous seizures, take a detailed history from the patient and witnesses to classify the seizure and explore causes. If not already done, check the blood glucose concentration and send blood for a full biochemical panel and blood count. Consider performing a urine drug screen. Perform computed tomography. Perform a lumbar puncture if intracranial infection is suspected. If an acute treatable cause is suspected, see acute symptomatic seizures. If an acute treatable cause is not found, suspect epilepsy.

If the patient has a history of previous seizures but is not being treated with an antiepileptic drug, investigate as above unless the results of previous investigations are known. Antiepileptic drug therapy is usually required (see advice).

If the patient has a history of previous seizures and is being treated with an antiepileptic drug, explore common seizure triggers (eg sleep deprivation, febrile illness, nonconcordance with therapy). Measure the plasma concentration of antiepileptic drug(s) if this is readily available.