Seizures occur when an uncontrolled burst of abnormal electrical activity in the brain results in abnormalities in muscle control, sensation, behavior, memory, and consciousness. Seizures that are not caused by the condition of epilepsy can occur due to an array of conditions such as high fever, sleep deprivation, withdrawal symptoms (alcohol, benzodiazepines), electrolyte disturbances, or hypoglycemia. Other medical conditions such as traumatic brain injuries, stroke, or brain tumors may also cause seizures.
Epilepsy is a seizure disorder where a patient has recurrent seizures. Epilepsy can occur at any age and is diagnosed when a person has had two or more unprovoked seizures. There is no cure for epilepsy, though some children may outgrow the disorder, and others may become seizure-free after years of treatment.
In this article:
- Classifications
- Nursing Process
- Nursing Assessment
- Nursing Interventions
- Nursing Care Plans
- Deficient Knowledge
- Ineffective Airway Clearance
- Risk for Aspiration
- Risk For Injury
Classifications
There are three classifications of seizures based on their onset, which are further identified by the motor components of the seizure activity.
Generalized Onset: the abnormal electrical activity affects groups of cells on both sides of the brain simultaneously. Examples of this type of seizure include tonic-clonic, absence, or atonic.
Focal Onset: the abnormal electrical activity begins in one area of the brain.
- Focal onset aware seizure (formerly known as a simple partial seizure): the patient is awake during this type of seizure.
- Focal onset impaired awareness seizure (formerly known as a complex partial seizure): the patient is confused or not fully aware of their surroundings during this type of seizure.
Note: a focal seizure is localized to one side of the brain. If the area of abnormal electrical activity spreads to both sides of the brain, the seizure can become tonic-clonic. This would be called focal to bilateral tonic-clonic. Patients often report experiencing an aura before the tonic-clonic seizure.
Unknown Onset: When the onset and details of a seizure are not known. As more information is obtained, a specific diagnosis may be determined.
Nursing Process
In the event of a seizure, the nurse’s priority is maintaining patient safety. When learning a patient has a history of or current diagnosis of seizures, seizure precautions should be implemented (bed in the lowest position, padded side rails, suction at the bedside). Long-term control of seizures requires education and strict adherence to a treatment plan which the nurse can encourage and support.
Nursing Assessment
The first step of nursing care is the nursing assessment, during which the nurse will gather physical, psychosocial, emotional, and diagnostic data. In this section, we will cover subjective and objective data related to seizures.
Review of Health History
1. Ask about the patient’s general symptoms.
Symptoms differ according to the type of seizure. Ask the patient what they remember before, during, and after the seizure occurred. Before a seizure, some patients report experiencing a prodrome or aura.
Symptoms of seizures can include:
- Noise or cry at the onset
- Sudden alteration in consciousness
- No response to verbal or painful stimulation
- Rhythmic motor movements (generalized tonic-clonic seizure)
- Prolonged gaze
- Involuntary movements of the arms and legs
- Urinary incontinence
- Tongue biting
- Weak or limp muscles
- Muscle twitching
- Clapping
- Lip smacking
Symptoms of the postictal state (after the seizure) can include:
- Transient alteration of consciousness
- Unusual perception
2. Determine the possible cause.
Evaluation of seizure activity requires determining whether the seizure was provoked or unprovoked. For patients with epilepsy, this may include determining seizure triggers, such as:
- Lack of sleep
- Illness
- Flashing lights
- Alcohol or drugs
- Stress
- Menstrual cycle
- Certain medications
- Excessive caffeine
3. Review the patient’s medical history.
While some patients have no identifiable cause for their epilepsy, possible causes include:
- Brain infections
- Autoimmune disorders
- Genetics
- Abnormal brain structures
4. Track history of head trauma or injury.
Acute head trauma may provoke seizure activity. An acute injury to the brain by an accident or stroke can lead to seizures. Damage to the brain lowers the individual threshold for seizure activity.
5. Review the patient’s medication list.
Inquire about any medication nonadherence for a patient diagnosed with epilepsy. Not taking antiseizure medications as prescribed may lower the seizure threshold and increase the risk of seizure activity.
6. Interview observers of the seizure.
Patients who lose consciousness or awareness during seizures may not be able to provide an accurate history. Ask observers or family members if anything occurred before (provoked) the seizure, what happened during the seizure, and how the patient felt/acted after the seizure.
Physical Assessment
1. Assess the ABCs.
During and after a seizure, immediately assess the ABCs (airway, breathing, and circulation).
Note: A common after-effect of seizure is respiratory depression. Continuous monitoring of ABCs is needed post-seizure.
2. Note the seizure characteristics.
In generalized tonic-clonic seizures, a stiffening or tonic phase is usually followed by clonic movements (rhythmically jerking movements). Other motor movements may include lip smacking, hand rubbing, or clapping. Not all seizures present with motor symptoms. For example, in absence seizures, the patient is observed to have a blank stare.
3. Assess the patient’s consciousness after a seizure.
Any brief change in consciousness, odd behavior, or unique perception could constitute the postictal state following seizure activity. This postictal period may last minutes to hours. The patient may be confused, tired, slow to respond, report a headache, and have difficulty with vision or speech.
4. Perform a neurologic and general assessment.
A neurologic and general physical examination should focus on identifying any neurologic impairments or injuries sustained during the seizure. Obtain vital signs frequently.
5. Inquire about an aura.
Some patients experience an aura that serves as a warning sign that a seizure is about to occur, though it is considered part of a focal seizure itself. The patient may describe the aura as a feeling of deja vu, a tingling sensation, a taste or smell, an intense feeling of fear or joy, a sound or color, or a sense of impending doom.
Diagnostic Procedures
1. Anticipate initial laboratory testing.
Patients without a known history of epilepsy will require evaluation to determine the cause of their seizures. Secondary causes such as electrolyte abnormalities, alcohol or drug use, or hypoglycemia can be identified through lab analysis.
2. Obtain serum levels of medications.
Some antiseizure drugs, such as valproic acid, require serum testing to achieve therapeutic levels. Patients who are nonadherent to their medication regimen will display subtherapeutic levels.
3. Consider a lumbar puncture.
Consider a lumbar puncture for patients with febrile seizures, a history of immunosuppression, or other symptoms that point to a potential central nervous system infection.
4. Anticipate neuroimaging.
Brain MRI or head CT scanning is recommended to evaluate for structural abnormalities causing seizures.
5. Assess the brain activity.
Electroencephalography (EEG) assesses the electrical activity of the brain and is used to diagnose and classify epileptic seizures.
Nursing Interventions
Nursing interventions and care are essential for the patients recovery. In the following section, you will learn more about possible nursing interventions for seizures.
1. Remain with the patient during a seizure.
For the patient who is actively seizing, perform the following:
- Note the time of the seizure
- Loosen clothing
- Clear the area around the patient
- Do not restrain the patient
- Never insert objects in the mouth
- Monitor the airway and breathing
- Stay with them until the seizure ends
- Place the patient in the rescue position
- Assess the patient for any injuries after the seizure
2. Stabilize the patient’s condition.
Provide supportive treatment that addresses airway, breathing, and circulation. When treating ongoing seizures, administer benzodiazepines (like lorazepam, midazolam, or diazepam) as ordered. In generalized convulsive status epilepticus, initiate advanced airway treatment.
3. Institute seizure precautions.
In the inpatient setting, institute seizure precautions for patients with a history of seizures. These measures include:
- Padded bed rails
- Bed in the lowest position
- Suction at the bedside
- Oxygen and resuscitation equipment at the bedside
- Removing hazards or furniture that could cause injury from falling
4. Treat alcohol withdrawal.
Patients with alcohol withdrawal seizures should be monitored closely for recurrence and treated for prevention with lorazepam.
5. Administer medications as prescribed.
A combination of antiseizure drugs is likely to be more effective than monotherapy. Numerous drugs are available as first-line or adjunctive treatments for epilepsy or seizure disorders, including:
- GABA receptor agonists:
- Benzodiazepines
- Barbiturates
- Sodium channel blockers:
- Carbamazepine
- Oxcarbazepine
- Phenytoin
- Lamotrigine
- Lacosamide
- Zonisamide
- GABA reuptake inhibitors:
- Tiagabine
- GABA transaminase inhibitors:
- Vigabatrin
- Valproic acid
- Glutamate antagonists
- Topiramate
- Felbamate
- Perampanel
- Medications that bind to the synaptic vesicle 2A protein
- Levetiracetam
- Brivaracetam
- Medications with multiple mechanisms
- Gabapentin
- Pregabalin
6. Ensure the patient has rescue medications available.
Rescue medications are taken as needed for situations when seizures are outside of the patient’s baseline, such as seizures that are more frequent or severe than normal. Benzodiazepines are the most common type of rescue medication and may be administered via the sublingual, buccal, rectal, or nasal route to get into the bloodstream faster.
7. Provide education on implanted devices.
For patients who do not respond to medications, neuromodulation treatment may be an option. This involves implanting a device in the brain that sends an electrical current to the nervous system to intercept seizures or change how brain cells work. Types of neuromodulation include:
- Deep brain stimulation (DBS)
- Responsive neurostimulation (RNS)
- Vagus nerve stimulation (VNS)
8. Discuss surgical options.
Consider epilepsy surgery when seizures are not controlled through medications or other treatments. Surgery removes the part of the brain causing seizures or disconnects the nerves that send seizure impulses to the brain. Surgery can be a cure for seizures or reduce the severity or frequency of seizures.
9. Encourage diet modification.
Diet modifications may be used in addition to medication. Two recommended diets include:
- Ketogenic diet: a high-fat, low-carbohydrate diet used primarily with children.
- Modified Atkins diet: similar to ketogenic, but with fewer restrictions. This diet includes higher calories with more protein.
10. Educate the patient about safety precautions.
Seizures are often unpredictable. Advise patients who experience epileptic seizures or other episodes of sudden-onset seizures to take the following precautions:
- Wear a medical alert bracelet
- Wearing a helmet when riding a bike
- Avoid swimming or taking a bath unsupervised
- Remain cautious around heat or fires
For patients whose seizures are not currently controlled:
- Avoid climbing stairs alone
- Do not work from unprotected heights
- Do not use power tools or operate heavy machinery
- Avoid high-risk activities (rock climbing, scuba diving)
Note: Each state has its own laws regarding driving for people with seizures. The patient may need to be seizure-free for 3 to 12 months to maintain a license.
11. Help the patient create a seizure action plan.
An action plan keeps important information in one place, so family members, caregivers, and emergency personnel know how to respond in the event of a seizure. An action plan includes patient information, a medication list, contact information for healthcare providers, and more. The patient should keep this plan with them at all times, and copies should be provided to schools, daycares, and caregivers.
12. Discuss complementary and alternative therapies.
Some patients may choose to seek complementary therapy in addition to medications or alternative treatment instead of conventional medicine. Options may include herbal remedies, vitamins, acupuncture, massage, chiropractic services, meditation, and more. The nurse can review potential benefits or risks with the patient.
13. Consider referral to an epilepsy center.
Patients with uncontrolled epilepsy may benefit from referral to an epilepsy center where specialists can offer video EEG monitoring for accurate diagnosis along with individualized treatment options.
Nursing Care Plans
Once the nurse identifies nursing diagnoses for seizures, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for seizures.
Caregiver Role Strain
Caregiver role strain can result from caring for a child or family member struggling with epilepsy or as a caregiver who personally has epilepsy and is experiencing difficulty in juggling responsibilities with their disorder.
Nursing Diagnosis: Caregiver Role Strain
Related to:
- Chronic seizures
- Unpredictability of seizures
- Lack of family support
- Insufficient finances
- Lack of resources
As evidenced by:
- Increased stress
- Anxiety, depression
- Disturbed sleep
- Inability to drive resulting in unreliable transportation
- Inability to maintain employment
- Inability to safely care for young children
- Isolation from family and friends
Expected Outcomes:
- Caregiver will identify resources to improve family processes
- Patient will report an improvement in caregiver role as evidenced by control of seizures
- Patient will voice realistic expectations of themselves as a caregiver
Assessment:
1. Assess the patient’s role as a caregiver.
Assess the full responsibilities of the caregiver whether they have seizures or they are a caregiver to someone with seizures.
2. Assess for a dependable support system.
Assess for other adults that provide support. A patient that is unable to work or drive due to their seizures will require the support of others.
3. Assess patients’ perception of their epilepsy and its impact.
A patient may feel that their disorder cannot be controlled and may give in to a loss of independence and isolation from living a full life. Encourage the expression of these thoughts to further apply interventions.
Interventions:
1. Recommend an epilepsy center.
All patients with epilepsy should have a neurologist they see regularly. More complex seizure disorders may require assessment at an epilepsy center that provides comprehensive testing and treatment.
2. Encourage delegation and coordination.
The caregiver with epilepsy or parent of a child with epilepsy must learn their strengths and weaknesses in their role. Coordinating and delegating tasks will allow the epileptic patient to feel useful and the caregiver will feel less burdened.
3. Offer resources.
Local epilepsy support groups assist with navigating the role of caregiving and being a caregiver with epilepsy. Grants and funds can assist with financial costs, housing, and transportation.
4. Refer to case management.
Nurse case managers can assist with supporting the patient with epilepsy or the parents of a child with epilepsy. They can provide education on surgical options, dietary recommendations, stress management, and coordinate care with epilepsy providers or other specialists.
Deficient Knowledge
A lack of knowledge regarding triggers, treatment, and prevention predisposes the patient to poor seizure control.
Nursing Diagnosis: Deficient Knowledge
Related to:
- Lack of understanding of seizure causes
- Poor understanding of seizure triggers
- Disinterest in seizure information
- Inability to recall provided education
As evidenced by:
- Poor adherence to medications
- Increase in seizures
- Injury from seizure activity
Expected Outcomes:
- Patient will verbalize an understanding of their type of seizure and related symptoms
- Patient will report recognizing their individual seizure triggers
- Patient will report adherence to their medication regimen with no missed doses for 30 days
Assessment:
1. Assess the patient’s knowledge of their seizure.
Many types of seizures present with their own set of symptoms. Assess the patient’s knowledge of precipitating factors such as auras, and modifiable risk factors that increase their risk of experiencing a seizure.
2. Assess the patient’s adherence to activity limitations.
Many state laws require a patient to be seizure-free for 6 months to operate a vehicle. Adhering to other safety precautions such as not partaking in high-risk sports or being unattended when swimming or even bathing. Assess the patient’s understanding of why these precautions exist and their adherence to them.
3. Review adherence to medications.
Missed doses of anti-seizure drugs can lead to breakthrough seizures. Review the patient’s understanding of strict adherence to their medication regimen.
Interventions:
1. Instruct on keeping a seizure diary.
The patient should be instructed to keep a log of their seizures including the date, time, duration, aura symptoms, and potential triggers. They may notice a pattern and be able to recognize triggers giving them more empowerment over their seizures.
2. Review potential triggers.
There are many potential triggers of a seizure and the patient should be educated on recognizing theirs. Common triggers include stress, flashing lights, menstruation or hormonal changes, medications, lack of sleep, illness, heavy alcohol use or withdrawal.
3. Help the patient to recognize warning signs.
Seizures can be unpredictable but there are often signs that a seizure is going to occur. An “aura” will be different for each patient but can include unusual feelings, smells, or sensations. The patient may describe an “out-of-body” experience or deja vu. The patient should learn to recognize these symptoms and prepare for an impending seizure.
4. Provide an action plan.
A diagnosis of epilepsy is life-long. An action plan includes information such as the patient’s medication list, healthcare contacts (neurologist, preferred hospital, pharmacy), medical history, and specific seizure details. The patient should have this available at all times and provide copies to their family members for continuity of care.
Ineffective Airway Clearance
Ineffective airway clearance can occur in patients during a seizure due to the tongue obstructing the airways, laryngospasm, retained secretions, or other causes.
Nursing Diagnosis: Ineffective Airway Clearance
Related to:
- Retained secretions
- Airway obstruction
- Neuromuscular impairment
- Respiratory depression
- Loss of reflexes
As evidenced by:
- Absence of/ineffective cough
- Excessive sputum
- Hypoxia
- Altered respiratory rhythm
- Cyanosis
- Adventitious breath sounds
- Tachypnea
Expected outcomes:
- Patient will maintain a patent airway.
- Patient will demonstrate effective airway clearance and equal and clear breath sounds bilaterally.
Assessment:
1. Assess and monitor the respiratory status.
Seizures can interfere with airway patency and normal breathing patterns, which can lead to inadequate oxygenation. Assessment will include respiratory effort, rate, rhythm, and depth.
2. Assess for obstructive sleep apnea.
Sleep disorders like obstructive sleep apnea can exacerbate seizure episodes and may result in the narrowing of the upper airways of patients when sleeping.
3. Assess and monitor oxygen saturation.
Ventilation and oxygenation may become compromised, especially with prolonged seizures and during the postictal phase. Respiratory depression is another concern following seizure activity. Closely monitor for hypoxia using a pulse oximeter.
4. Assess the patient’s ability to cough and swallow effectively.
The inability to cough and/or swallow effectively can compromise airways by preventing secretions from being cleared effectively.
Interventions:
1. Administer supplemental oxygen as indicated.
During a seizure, ABCs (airway, breathing, circulation) must be prioritized. Administering supplemental oxygen via a non-rebreather mask is often indicated to prevent prolonged oxygen desaturation.
2. Position the patient in the recovery position during and after a seizure.
While in the recovery position, the body should be turned on one side, with the mouth facing toward the ground. This position assists with breathing, helps maintain patent airways by promoting drainage of secretions, and prevents the tongue from obstructing the airway. The head should also be supported or cushioned.
3. Loosen the patient’s clothing.
Loosening restrictive clothing, especially around the neck, chest, and abdomen, can help ensure a patent airway and the most effective breathing pattern.
4. Suction the patient as appropriate.
During a seizure episode, never attempt to insert a suction catheter into the patient’s mouth. Apply suction only to the outside of the mouth to remove secretions during a seizure and only inside the mouth when the seizure activity has stopped.
Risk for Aspiration
Patients with seizure disorders have an increased risk for aspiration of saliva, blood, and vomit during a seizure and in the postictal phase.
Nursing Diagnosis: Risk for Aspiration
Related to:
- Ineffective airway clearance
- Airway obstruction
- Loss of gag reflexes
- Neuromuscular impairment
- Decreased level of consciousness
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred. Nursing interventions are aimed at prevention.
Expected outcomes:
- Patient will maintain a patent airway and clear lung sounds.
- Patient will remain free from any complications associated with aspiration, including aspiration pneumonia and respiratory distress.
Assessment:
1. Assess for secretions, blood, and vomitus during a seizure episode.
The presence of secretions, vomitus, and blood during a seizure episode can increase the patient’s risk for aspiration.
2. Assess and monitor the patient’s oxygen saturation.
Oxygen saturation may decrease temporarily during a seizure but should recover during the postictal phase. Late onset of decreased oxygen saturation may indicate developing aspiration pneumonia.
3. Identify patients at a higher risk for aspiration.
Infants, young children, older adults, and patients who are developmentally delayed may be at an increased risk for aspiration when experiencing a seizure due to issues such as a poor gag reflex, ineffective cough, increased secretions, or dysphagia.
Interventions:
1. Do not insert anything into the mouth during a seizure.
Nothing should be inserted into the mouth during a seizure that could increase the risk of choking or injury.
2. Instruct the patient to remove dentures when not in use.
Removing dentures and other objects from the mouth when not in use can help reduce the risk of aspiration during a seizure episode.
3. Administer suction as needed.
Suctioning when it is safe will help reduce the risk of aspiration in patients with seizures. Excessive saliva or the presence of vomit can accumulate in the mouth, obstruct the airways, and increase the risk of aspiration.
4. Keep the patient NPO until fully alert.
The postictal phase starts when the seizure activity stops and when the patient regains full consciousness. The patient may feel confused, drowsy, and disoriented during this stage. Instruct the patient not to drink or eat until fully alert to prevent aspiration.
Risk For Injury
Seizures can result in a loss of awareness, consciousness, and voluntary control of the body increasing the risk of falls, injury, and trauma.
Nursing Diagnosis: Risk For Injury
Related to:
- Loss of muscle control
- Falls
- Loss of consciousness
- Altered sensations
- Convulsions
- Impaired swallowing/airway clearance
Note: A risk diagnosis is not evidenced by signs and symptoms as the problem has not occurred yet and the goal of nursing interventions is aimed at prevention.
Expected Outcomes:
- Patient will remain safe and free from injury when experiencing a seizure
- Patient will modify their environment to prevent injuries from seizures
- Patient and family members will verbalize how to keep the patient safe during a seizure
Assessment:
1. Explore seizure patterns.
Help the patient identify specific times or triggers of seizure activity and how to recognize symptoms so they can keep themselves safe or alert someone else to monitor them.
2. Assess availability of family/caregiver.
Assess if the patient has family support or if they live alone. If caregivers or support is available, ensure they understand what to do in the event of a seizure.
Interventions:
1. Ensure a patent airway.
Turn the patient into their side if lying to maintain an open airway and prevent aspirating. Loosen clothing around the neck. Do not place any objects in the mouth. Apply oxygen if the patient displays respiratory distress.
2. Remove hazardous items.
Remove unnecessary furniture or sharp objects that could cause injury during a fall. Keep their bed in the lowest position.
3. Do not restrain, monitor closely.
A patient who is actively seizing should never be restrained as this can further increase injury. Keep them safe by providing pillows or padding if on a hard surface. Patients in the hospital often have their bed rails padded and a mat on the floor.
4. Instruct on activities that require additional precautions.
A seizure can occur at any moment. Working at heights, swimming unattended, using heavy machinery or power tools, and even driving can be dangerous for a patient, especially if their seizures are not controlled.
5. Encourage a medical alert bracelet or identification.
When a medical emergency occurs, having a medical alert bracelet on or easily accessible identification will assist medical personnel in appropriately treating the patient during a seizure.
References
- Al Sawaf A, Arya K, Murr N. Seizure Precautions. [Updated 2021 Sep 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536958/
- Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2008). Nurse’s Pocket Guide Diagnoses, Prioritized Interventions, and Rationales (11th ed.). F. A. Davis Company.
- Evaluation of a First-Time Seizure. (n.d.). Johns Hopkins Medicine. Retrieved February 28, 2022, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/epilepsy/evaluation-of-a-firsttime-seizure
- First Aid for Seizures. (2015, August 10). Cleveland Clinic. Retrieved February 28, 2022, from https://my.clevelandclinic.org/health/articles/6998-seizures-first-aid
- Huff, J. S., & Murr, N. (2023, February 7). Seizure – StatPearls – NCBI bookshelf. National Center for Biotechnology Information. Retrieved November 2023, from https://www.ncbi.nlm.nih.gov/books/NBK430765/
- Ko, D. Y. (2022, July 26). Epilepsy and seizures clinical presentation: History, physical examination, overview of epileptic seizures classification. Diseases & Conditions – Medscape Reference. Retrieved November 2023, from https://emedicine.medscape.com/article/1184846-clinical#b6
- Ko, D. Y. (2022, July 26). Epilepsy and seizures treatment & management: Approach considerations, anticonvulsant therapy, anticonvulsants for specific seizure types. Diseases & Conditions – Medscape Reference. Retrieved November 2023, from https://emedicine.medscape.com/article/1184846-treatment#d16
- Ko, D. Y. (2022, July 26). Epilepsy and seizures workup: Approach considerations, prolactin study, serum studies of anticonvulsant agents. Diseases & Conditions – Medscape Reference. Retrieved November 2023, from https://emedicine.medscape.com/article/1184846-workup#c1
- Kiriakopoulos, E. (2022, March 1). Types of seizures. Epilepsy Foundation. https://www.epilepsy.com/what-is-epilepsy/seizure-types#How-Are-Seizures-Classified-Now?
- Ladwig, G. B., Ackley, B. J., Makic, M. B. F., Martinez-Kratz, M. R., & Zanotti, M. (2020). Mosby’s Guide to Nursing Diagnosis. Elsevier.
- Schachter, S. C. (2021, July 22). Learn / Triggers of Seizures. Epilepsy Foundation. Retrieved February 28, 2022, from https://www.epilepsy.com/learn/triggers-seizures
- Seizure: What it is, causes, symptoms & types. (2022, April 13). Cleveland Clinic. Retrieved November 2023, from https://my.clevelandclinic.org/health/diseases/22789-seizure
- Seizures – Diagnosis and treatment – Mayo Clinic. (2023, September 2). Top-ranked Hospital in the Nation – Mayo Clinic. Retrieved November 2023, from https://www.mayoclinic.org/diseases-conditions/seizure/diagnosis-treatment/drc-20365730
- Service Coordination/Case Management Programs. (n.d.). Epilepsy Foundation. Retrieved February 28, 2022, from https://www.epilepsy.com/local/northeastern-new-york/programs/service-coordinationcase-management-programs
