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Old 11-07-2010, 09:34 AM
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Default Epilepsy

I need info on new onset epilepsy. Jess's bf [gag], had several seizures last noc. He went to the ER and they dx'd epilepsy. He had 2 seirsures while in the ER. They released him home at 0330.

I need to know if this is SOP for new dx? They prescribed dilantin but didn't send any home with him. Told Jess he needed to go to the free clinic tmro.

What causes epilepsy? Jess asked if it was concussions. HELP!!
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Old 11-07-2010, 09:47 AM
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Hi Karen,

Anything can cause epilepsy. Sometimes it is idiopathic. Known causes are TIAs, brain infections, tumors, lesions, etc. I think it is best he is seen by a neurologist for extensive testing as I don't see how an ER could figure out much past the fact that he had a seizure. He could have also seized from alcohol or drug use. Me thinks he needs a CBC, CSF, blood sugar, kidney and liver analysis as well to see if something else is the underlying cause for the seizure. Do you know what kind of seizure he had? Tonic clonic (grand-mal), partial (focal)?
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Old 11-07-2010, 09:58 AM
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PS I mean no disrespect against ED nurses or docs but there is a certain ED near my house that is notorious for labeling anyone who has a seizure a epileptic. I know of 3 frequent flyers that are meth addicts but that ED calls it epilepsy so they can get them out of there STAT. I have yet to see anyone leave that ED after a seizure with a referral to a neurologist or a script for dilantin.
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Old 11-07-2010, 11:21 AM
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I agree with Bee. The ED here on base is NOTORIOUS for mis-diagnosing. I have been a victim of a misdiagnosis myself there. I'd make sure he get a second opinion about it for sure.
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Old 11-07-2010, 11:42 AM
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Epilepsy can result from a tumor, infection, or damage to the brain.
Children and older adults are most likely to develop epilepsy, but it can start at any age. It is possible that epilepsy can run in families, but you do not have to have a family history to develop epilepsy.
Epileptic seizure occur when abnormal bursts of electricity in the brain briefly upset normal brain function. It's not always clear what triggers the bursts of abnormal electrical activity.
Conditions that can cause seizures include:
  • Any head injury/trauma.
  • Stroke or conditions that affect the blood vessels (vascular system) in the brain.
  • Hardening of the arteries in the brain.
  • Brain tumor.
  • Brain infection, such as meningitis or encephalitis.
  • Alzheimers's.
And even without any of the above conditions you can still develop epilepsy. Things that can make you more prone to seizures once diagnoses is confirmed:
* not enough sleep/rest
* skipping meals
* emotionally stressed
* drugs/alcohol use
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Old 11-07-2010, 11:44 AM
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My computer is possessed. Middle part was same font as rest of it but when I went to post it changed sizes on me. Wonder how I messed that up?
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Old 11-07-2010, 11:58 AM
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Good info ladies, I am wondering what he has been drinking or using to start with either way this needs to be assessed by a Neurologist due to first time seizures.
He should have been sent home with some medication too
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Old 11-07-2010, 12:33 PM
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Karen, Dilantin is not a benign med and should not be taken lightly. It is one of those narrow therapeutic level drugs that has to be closely monitored to avoid toxicity, particularly when first starting it. It also comes with all manner of potential side effects. As the others have said, I highly recommend a neuro consult.
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Old 11-07-2010, 05:39 PM
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Emergency rooms here will send pt's home with scripts for meds, but they won't send them home with the med.
I agree he needs a follow up. You don't want to scare Jess or him by giving them all info you can find on epilepsy, they need a consultation with Neuro.
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Old 11-07-2010, 06:46 PM
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Being a former ER nurse I can tell you that 9/10 times you will not get an accurate diagnosis from the ER. It is not in the nature of the ER to diagnosis as a specific specialist would do. It is solely a treat and street mentality---focused only for the chief complaint and diagnosis by ruling out the most life threatening causes for the chief complaint. So, with a chief complaint of seizure activity, brain bleeds and tumors should be eliminated and a tox screen done. Remember that you are not privy to the results of tests, but sending him home rather than admitting him tells me to ask for the results of that tox screen.

Best advise I can give is to stay detached and let it play itself out. You made your feelings known about bf and you should avoid getting drawn in to the drama for now.
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