This study aims to identify and optimize the evaluation algorithm in our institution for patients who present to the emergency department (ED) with new-onset seizures (NOS) and evaluate follow-up variables based on seizure etiology post discharge.

Retrospective study collecting data from ED visits on patients who presented at Parkland Hospital in Dallas, TX (a safety-net county facility) with a primary diagnosis of seizure from February 2019-January 2020. Data collected included demographics, prior seizure history, clinical workup, and follow-up. All NOS patient management steps and follow-up are documented as a case-series.

Of 232 eligible patients, 23 presented with NOS. Ten (43.4%) were determined to be provoked seizures as follows: 5 alcohol withdrawal/drug ingestion, 2 electrolyte abnormalities, 1 infection, and 2 DKA. Six (26.1%) had intracranial lesions. The etiology in 7 of 23 (30.4%) NOS cases remained unknown; each of these patients had a negative CT-head, and no other provoking factors were found with lab work/imaging. A total of sixteen patients, including all 7 with unknown etiology and 5 with intracranial lesions, had outpatient Neurology referrals (69.6%), but only 6 attended (26.1% of total NOS). None from the unknown etiology group and 3 from the intracranial lesion group attended.

All NOS patients had appropriate ED evaluation. Neurology referrals were placed for the majority of patients, but attendance at follow-up was poor. Further study is needed to determine barriers for patients in getting a neurology referral and in determinants of poor outpatient clinic attendance.