ACEP Clinical Policy — First Unprovoked Seizure and Status Epilepticus (2024)

The ACEP 2024 Clinical Policy on evaluation and management of adult ED patients with first unprovoked seizure provides evidence-based guidance on: risk stratification for seizure recurrence, neuroimaging and EEG indications, antiepileptic drug (AED) initiation decision-making, and safe disposition. A separate component addresses status epilepticus (SE) management — seizure activity ≥ 5 minutes (ILAE 2015 operational definition) or two seizures without return to baseline — which represents a medical and neurological emergency requiring rapid benzodiazepine administration and escalating treatment if initial therapy fails.