Acute management of seizures

Seizures may be a manifestation of epilepsy, but may also have other causes, including toxic or metabolic disturbances, or an acute insult to the brain, such as head injury or encephalitis. Most seizures are self-limiting, and will have ceased before the patient arrives at hospital. Where they are ongoing, the priority is resuscitation of the patient and appropriate treatment to terminate the seizure. In those in whom the episode has ceased, an eyewitness description of the event is crucial for confirmation of diagnosis. Investigations should be directed at excluding other possible causes of loss of consciousness (such as cardiac arrhythmias, where there is an appropriate history) and confirming the cause of the seizures. All patients with a new diagnosis of epilepsy should be referred to a specialist for further assessment and consideration of treatment. Patients and carers should be counselled about the implications of seizures and first aid management.