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Seizure Telephone Triage

The following will provide a general guideline for office clinical staff when responding to a parent call about a child with a seizure:
  • When a paroxysmal event occurs in a child without a previously known explanation, they should be seen emergently.
  • When the child has a known seizure disorder, and the family calls to report a seizure and discuss the child's care, there is often an expectation for action. It is important to first assess the situation:
    • Inquire about the patient's current condition, the timing of onset of the new seizure(s), duration, and severity. Confirm current medications with the medical record.
    • Inquire about possible transient aggravating factors, such as concurrent illness (particularly with fever), sleep deprivation, additional medications or drugs being taken, or other specific precipitants (e.g., photic stimulation).
    • Inquire about recent compliance with antiepileptic drugs (AED) and presence of any side effects associated with the medication(s).
    • Inquire about the parents' understanding about what to do at this point and assess their level of anxiety/concern.
  • If the patient is stable, parents are comfortable, and there is reason to believe that the seizure was due to inadequate AED levels (recent missed doses, lowish level when last checked, no AED side effects, etc.), increasing the dose and planning to check a level soon may be a safe plan of action.
  • If the likely cause of the seizure flare is a concurrent illness, the best strategy may be to treat the illness, provide antipyretics (which may not affect seizure control, but will provide comfort to the patient), and provide a back-up plan if further worsening occurs, such as rectal diazepam or nasal midazolam for severe clusters.
  • The phone call can also present an opportunity to discuss other important items:
    • Reviewing the implications of a single seizure;
    • Discussing ways to reduce the risk of recurrent events; and
    • Working out strategies for managing emergencies.
  • All children with seizures should have a seizure action plan for what to do in case of a breakthrough seizure. This can be developed with either the Medical Home clinician or with the pediatric neurologist at the next visit. Such a plan is crucial in providing good care to a child with seizures.

Authors

Compiled and edited by: Lynne M Kerr, MD, PhD - 6/2011
Content Last Updated: 5/2011