Seizure disorder: The Daily PANCE Blueprint

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Seizure disorder: The Daily PANCE Blueprint

A 45-year-old man presents to the emergency department after experiencing a convulsive episode witnessed by his wife. He has no significant past medical history and takes no medications. His wife reports that he had generalized tonic-clonic movements lasting about 2 minutes, followed by a period of confusion. He has now returned to his baseline mental state. His physical and neurological examinations are unremarkable. Laboratory studies including electrolytes, glucose, calcium, magnesium, complete blood count, renal function tests, liver function tests, and urinalysis are normal. An electrocardiogram (ECG) shows no abnormalities. What is the most appropriate next step in the management of this patient?

A. Immediate initiation of antiseizure medication
B. Discharge with close outpatient neurology follow-up
C. Perform an urgent electroencephalogram (EEG)
D. Hospital admission for further evaluation
E. Lumbar puncture to rule out central nervous system infection

Answer and topic summary

The answer is B. Discharge with close outpatient neurology follow-up

This patient experienced a first unprovoked seizure, which is a seizure of unknown etiology. After a first unprovoked seizure, if the patient has returned to their clinical baseline and initial studies, including laboratory tests and ECG, are normal, they can typically be discharged from the emergency department with close outpatient follow-up. This follow-up should include a thorough neurological evaluation and possibly an electroencephalogram (EEG) to assess for an underlying seizure disorder.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Neurology ⇒ Seizure disorders

Also covered as part of the Family Medicine EOR, Emergency Medicine EOR, Internal Medicine EOR, and Pediatric EOR topic lists