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View Full Version : Questions about epilepsy and hospital treatment



DancingMaenid
02-13-2015, 11:39 AM
I'm writing a story where a character has epilepsy, and while I've done a fair amount of reading on it, there are a few things that I'm unsure on.

Here the scenario: Character is an adult man in his early 30's. He was diagnosed with temporal lobe epilepsy as a child, and was on medication for it throughout his teens. As an adult, he stopped taking his medication without a doctor's supervision.

After being seizure-free for several years, he begins having seizures again. At one point, he has a tonic-clonic seizure, during which he falls and hits his head. The paramedics are called, and by the time they arrive he's awake and somewhat responsive, but still a bit dazed from the seizure. They take him to the hospital, partially because he needs stitches for a head wound sustained in the fall.

Under circumstances like these, would the ER doctor likely order an MRI for him or prescribe medication to try to prevent future seizures? Or, since he has a known history of epilepsy, would the doctor just send him on his way with the recommendation of seeing a specialist ASAP? I know that in general, seizures aren't seen as medical emergencies if they're explainable. But I wasn't sure if, because the character has been without medical treatment for a while, the ER doctor would want to give him a more thorough exam. Also, he's not currently on any medication to manage his condition.

Two, I've gotten the impression from my reading that it is plausible that someone who's been seizure-free for a while could start experiencing seizures again. Especially if they didn't grow out of their epilepsy as a young child, but continued to suffer from it as they grew up. But I would appreciate opinions on that. I do want this part of the story to seem plausible.

Thanks for the help!

ap123
02-13-2015, 03:42 PM
The ER doc would be unlikely to order an MRI, but would tell him to go see a neuro, who *might.* Most cases of epilepsy are idiopathic (no known cause), and odds are he had at least one full work up including MRI as a child. If you want the character to have it done, the ER doc could stress seeing a neuro (especially if he had another sz while in the ER), and the neuro could easily want one done because MRIs have improved/the magnets are stronger. There is, btw, a specific "epilepsy protocol" that is often ordered for MRIs done for someone with epilepsy.

If he had another sz while in the waiting room, or if they did a quick EEG and found epileptiform activity, it's likely the dr would prescribe meds, possibly giving a "loading dose" through an IV while he's there.

Yes, there is a significant percentage of people who have epilepsy as children, appear to "grow out of it," who then begin having seizures again as adults. But...as you've laid it out, he was never told he was seizure free, he just stopped taking his meds. If they were still being prescribed after 1-2 years of being sz free, there's a good chance his EEGs showed epileptiform activity.

*I am not a doctor, nor do I play one on tv, but I have lots of experience as a parent.

nikkidj
02-14-2015, 03:35 AM
The Emergency Department doc would be more likely to order a head CT to rule out a head bleed. If the patient has a long-standing case of epilepsy, an MRI isn't likely to be ordered, especially from the ED. If it's been that long since the patient had his most recent seizure, the doc might order a set of electrolytes, just to make sure that nothing else is contributing to the seizures. The doc would likely then consult with a neurologist, give a large dose of anti-seizure medication (like Keppra or Dilantin) to "load" the system, and send the patient out on a sufficient dose of anti-epileptics, the caveat being the patient has to agree to follow up in the near future.

Albedo
02-14-2015, 04:07 AM
Yep, head CT über alles, soon as he reaches the ED. There's no way to tell whether the confusion is just post-seizure or from an intracranial haemorrhage, otherwise.

DancingMaenid
02-14-2015, 11:01 AM
This is quite helpful! Thank you so much for the responses! I hadn't thought much about CT scans.

CoolBlue
02-15-2015, 10:00 AM
Just in case it's not obvious: The one thing the person will leave WITHOUT is the approval to drive, pilot, etc.

HTH