Check for:
Head / C-spine injuries
Tongue/mouth lacs
Sides of tongue (true<unk>  more often bitten than tip of tongue (psychogenic nonepileptic<unk> , formerly "pseudoseizure.")
Tongue biting has sensitivity of ~25% and approaches 100% specificity in lateral tongue biting
Posterior shoulder dislocation
Focal deficit (Todd paralysis vs CVA)
If new, treat as presumed stroke. Cannot be ruled as Todd's without stroke workup.
Nuchal rigidity (concern for meningitis)
Head / C-spine injuries
Tongue/mouth lacs
Sides of tongue (true<unk>  more often bitten than tip of tongue (psychogenic nonepileptic<unk> , formerly "pseudoseizure.")
Tongue biting has sensitivity of ~25% and approaches 100% specificity in lateral tongue biting
Posterior shoulder dislocation
Focal deficit (Todd paralysis vs CVA)
If new, treat as presumed stroke. Cannot be ruled as Todd's without stroke workup.
Nuchal rigidity (concern for meningitis)
Sides of tongue (true<unk>  more often bitten than tip of tongue (psychogenic nonepileptic<unk> , formerly "pseudoseizure.")
Tongue biting has sensitivity of ~25% and approaches 100% specificity in lateral tongue biting
If new, treat as presumed stroke. Cannot be ruled as Todd's without stroke workup.
Non-contrast head CT in ED (or advanced imaging arranged as outpatient)
First time<unk> s in setting of EtOH or EtOH-withdrawal: 6.2% had clinical significant lesion.
Point-of-care glucose
Pregnancy test
CBC & chemistry
ECG (prolonged QT and torsades can cause shaking after intermittent runs}
Consider prolactin or lactate to assist in differentiating<unk> s from psychogenic nonepileptic<unk>  or volitional<unk>  activity (lactate may be detectable for up to 1 hour post-seizure)
Consider: Utox, RPR, HIV, UA, EEG, lumbar puncture, EtOH level, CK
First time<unk> s in setting of EtOH or EtOH-withdrawal: 6.2% had clinical significant lesion.
Anticonvulsant drug concentration
Point-of-care glucose
Trauma workup, if appropriate
Consider head CT scan if prolonged postictal period or trauma
Seizure
Epileptic seizure
Febrile seizure
First-time seizure
Status epilepticus
Seizure with known seizure disorder
Syncope
Syncope 