1. Emergency physicians need not initiate AEDs in the emergency department for patients who have had a first provoked seizure. Precipitating medical conditions should be identified and treated. (AEDs, for these three recommendations and throughout the document, refer to medications prescribed for seizure prevention.)
2. Emergency physicians need not initiate AEDs in the emergency department for patients who have had a first unprovoked seizure without evidence of brain disease or injury.
3. Emergency physicians may initiate AEDs in the emergency department, or defer in coordination with other providers, for patients who have experienced a first unprovoked seizure with a remote history of brain disease or injury.⁴

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References

1. Pallin DJ, Goldstein JN, Moussally JS, et al. Seizure visits in US emergency departments: epidemiology and potential disparities in care. Int J Emerg Med. 2008;1:97-105.
2. Hauser WA, Beghi E. First seizure definitions and worldwide incidence and mortality. Epilepsia. 2008;49(suppl 1):8-12.
3. Krumholz A, Wiebe S, Gronseth G, et al. Evidence-based guideline: management of an unprovoked first seizure in adults. Report of the Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2015;84:1705-1713. Available online at: http://www.neurology.org/content/84/16/1705.full. Accessed May 6, 2016.
4. Huff J, Melnick E, Tomaszewski C, et al. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with seizures. Ann Emerg Med. 2014;63:437-447.