Abstracts

Provision for first seizure review inthe UK has traditionally been patchy. In order to cut misdiagnosis rates and address important social and medical issues, NHS board in Glasgow set up a First Seizure Service in 2002 to allow rapid assessment of all new onset loss of conciousness. Information on diagnostic profile, outcomes and investigation results were collected for all previously untreated patients attending the North Trust First Seizure service between January 2003 and May 2004 470 patients have been seen and assessed so far. Referral s had come mostly from General Practitioners and Emergency Room physicians.
23% of patients referred had their episode diagnosed as syncope. In these patients, AED treatment was therefore avoided and investigation with imaging and EEG was used more sparingly.
25% had an ictal cause of their loss of conciousness confirmed. Appropriate counselling and investigation was used in these cases.
18% gave a history of previous ictal events (complex partial seizures, nocturnal generalised tonic clonic seizures, or myoclonic jerks) when directly asked which had not been elicited by the referring generalist; in these patients, treatment was able to be started as the diagnosis of epilepsy was confirmed.
55 patients had been started on AEDs by the referring clinician; in 83% of these, treatment was either withdrawn (as inappropriate or dangerous). First seizure clinics prevent misdiagnosis of epilepsy and allow for far more appropriate use of investigations and AEDs. Generalists and Emergency Room physicians should not be starting treatment with AEDs.