Evaluation and Management of New-Onset Unprovoked Pediatric Seizures: A Guide for Primary Care Providers

Seizures are a frightening and potentially life threatening neurological occurrence that Primary Care Providers are ill prepared to evaluate and manage. Although febrile seizures and the role of the Primary Care Provider in managing them are well defined, there are currently no clear guidelines for the management of unprovoked seizures in Primary Care. There is no clear expert consensus on what seizure types can be safely managed in primary care. Guidelines for the use of EEG and imaging are well established but often underutilized by Primary Care Providers. The purpose of this project is to create a guide that will help Primary Care Providers feel more comfortable in evaluating and diagnosing pediatric seizures and to provide direction in the management of select seizure types. Objectives: 1. Identify the most common unprovoked seizures of childhood Evaluation: I have submitted this guideline to my content experts and received informal approval 2. Create a primary care provider's guide for the assessment, diagnosis and treatment of a first seizure Evaluation: I have submitted this guideline to my content experts and received informal approval 3. Develop guidelines for referral of the patient with a first seizure to pediatric neurology Evaluation: I have submitted this guideline to my content experts and received informal approval 4. Submit a manuscript for peer review to a relevant journal Evaluation: This manuscript has been submitted, see Appendix C, pg. 34. 5. Submit a poster project for display at the annual Nurse Practitioners of Oregon Education Conference Evaluation: This poster presentation has been submitted, see Appendix D, pg. 35. Summary: Though there is little current evidence regarding safety of seizure management in primary care, based upon the predictability and clinical pathway that many seizure disorders take in childhood there are seizure types that can theoretically be managed safely in primary care. These include absence seizures, generalized tonic clonic seizures, and benign rolandic epilepsy. Patients with complex co-morbid conditions and patients with partial onset epilepsy, pseudoseizure, focal neurologic findings, or seizures that don't respond to the first appropriate agent should be referred.