Preventing Epilepsy Deaths: Clinician Toolkit
Assessment & Action Guide

High Risk Seizures

Patients with high risk seizures need to be assessed for the following at their initial visit, follow up visits and during life transitions.
Assess seizure type, duration, frequency, nocturnal seizures, cluster seizures, status epilepticus, and infantile spasms.
Clinician actions
  • Educate patients and families on seizure types and increased risk factors to be aware of.
  • Counsel on the importance of seizure supervision (See unsupervised seizure).
Assess for treatment-resistant epilepsy, also called refractory, intractable or uncontrolled epilepsy. Treatment resistance is “failure of adequate trials of two tolerated, appropriately chosen and used anti-epileptic drug schedules (whether as monotherapies or in combination) to achieve sustained seizure freedom”.
Clinician actions
  • If treatment resistant epilepsy is discovered, consider referral to comprehensive epilepsy services.
  • Counsel on the importance of treatment adherence.
Identify epilepsy syndromes and etiologies associated with high morbidity and mortality.
Clinician actions
  • Consider referral to or consultation with comprehensive epilepsy services.
  • If patient is seen by multiple Clinician care providers, develop mechanisms for communication and coordination of care.
Conversation tips
Learn how to discuss high-risk seizures with your patients