ACEP guidelines6 recommend neurologic consultation for patients with first-time seizures, seizures with persistent altered mental status, new focal neurologic deficits, and new intracranial lesions (T§ble224-7). Pregnant patients and those with a marked change in seizure pattern or poorly controlled seizures may also warrant consultation. Hospital admission is recommended for patients with persistently altered mental status, and for patients with seizures due to CNS infections, new intracranial lesions, or clinically significant hypoxia, hypoglycemia, hyponatremia, or dysrhythmias ( T§.b.ie 2.2.4.-8). Patients with status epilepticus or seizures in the setting of eclampsia or head trauma should also be admitted. Alcohol or drug-related seizures do not necessarily require admission, although detoxification or withdrawal should be addressed.
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