Consultant’s corner: the “breakthrough” seizure

Abstract Seizures are a common cause of emergency department visits. This article provides an algorithm for evaluation and management of the patient with a known seizure disorder who presents with a breakthrough event. If the seizure represents a significant deviation from the usual pattern or the patient has an established pattern of episodes of status epilepticus, early involvement of the consultant neurologist is warranted. Otherwise, the first step is to search for provocative influences such as fever, intercurrent illness, or non-compliance with prescribed anti-epileptic drugs. Measurement of drug levels will guide the next rational phase of management. The overwhelming majority of patients can be managed following this logical framework.