Seizure Investigations

Investigations you do are always driven by specific patient parameters but an approach to what you can do is below.

Lab Investigations

• Glucose (BSL done immediately if low give glucose IV)

• FBC (usually transiently high post ictally, returns in hours to days, may be high in sepsis or central infection)

• EUC (may indicate underlying precipitant, Na)

• LFT (if indicated by known past history, ETOH ingestion, liver disease)

• Ca (abnormalities cause seizures)

• Urine BHcg (if indicated)

• VBG (metabolic snapshot, useful particularly if ingestion suspected, think toxidromes)

Imaging, head CT (do you want contrast)

For any first or partial seizure or suspicion of:

• trauma

• malignancy

• immunocompromise

• anticoagulation

• new focal neurological findings on examination

Imaging in known seizure disorder

Head CT for:

• new focal deficits

• trauma

• persistent fever

• new character or pattern to the seizures

• suspicion for AIDS, infection

• anticoagulation

Lumbar puncture for:

• immunocompromise

• persistent fever

• severe headache

• persistently altered mental status

Other

• ECG

• EEG

• MRI