Seizure F050

Current RMA Instruments

Changes from previous Instruments

ICD Coding

• ICD-10-AM Code: R56.8

Brief description

An (epileptic) seizure is a temporary event in which there is uncontrolled electrical activity in the brain, which may produce a range of manifestations including physical convulsion, loss of consciousness, minor physical signs, and thought disturbances.

Confirming the diagnosis

Diagnosis is normally based on specialist opinion and imaging of the brain is usually undertaken.  Appropriate other investigations in the circumstances of the case will be undertaken to look for underlying pathology and identify whether there has been a precipitating cause.

There is a separate SOP for epilepsy.  The epilepsy SOP applies if there have been at least two seizures, more than 24 hours apart and not due to an acute (short term) precipitating cause, such as a low blood sugar level, high blood calcium level or acute brain hypoxia (decreased oxygen supply) at the time of the seizure.

The (epileptic) seizure SOP applies if:

• There has only ever been one seizure event (multiple seizures within a 24 hour period = 1 event), or
• There has been an acute precipitating cause for a seizure.

Both SOPs may apply in the one case:

• If a claimant has epilepsy (and that SOP applies or has been applied previously), but there is a new seizure event, due to an acute precipitating cause, then the seizure SOP will also apply.
• Two seizure events, not due to an acute precipitating cause, are required to establish a diagnosis of epilepsy.  If there has been only one such seizure, the seizure SOP applies, if there is subsequently a second such seizure, the diagnosis of epilepsy can then be made and the epilepsy SOP would then apply (and the seizure diagnosis would be subsumed).  There may be months, years or even decades between such seizures.

The appropriate medical specialist is a neurologist.

Additional diagnoses which may be covered by SOP

• epileptic fit

Conditions excluded from SOP

• epilepsy*
• febrile seizures^# 
• infantile seizure; neonatal seizures^# 
• movement disorders associated with sleep including restless legs syndrome* and periodic limb movement disorder*, cataplexy^# 
• reflex epilepsy* - epilepsy SOP
• paroxysmal neurological symptoms due to syncope/ faint; G-forced induced loss of consciousness; migraine; vertigo - symptom, not disease or injury by itself
• hysterical or psychogenic seizure^# 

* another SOP applies

# nonSOP condition

Clinical onset

Clinical onset will be when the seizure event occurred.  A clear history of the event may not be available.

Clinical worsening

The only SOP worsening factor is for inability to obtain appropriate clinical management.  Most seizures resolve within a few minutes, before medical attention can be given.  Prolonged seizures may require treament with antiseizure drugs.  Other management measures may be directed at identifying and treating underlying triggers.