First seizures, the epilepsies and other paroxysmal disorders prospective audit of a first seizure clinic

Background: Despite high life time prevalence of first seizures there is a dearth of information relating to uptake and efficient use of resources for first seizure services. Aims: To determine referral pattern, epilepsy and non-epilepsy diagnoses, investigations performed, follow-up appointments generated and resource utilisation at a first seizure clinic. Methods: A prospective study of 200 consecutive attendees was performed over a 16 month period at a first seizure clinic in the Institute of Neurological sciences, Glasgow. Results: 139(69.5%) patients were general practitioner and 61(30.5%) hospital referrals. Fifty-six (28%) patients were newly diagnosed with epilepsy and 26(13%) witha an unprovoked first seizure. Alcohol and/or drug abuse were contributing factors in 23 patients or 19.5% of all seizure cases. Twenty-one (35%) of 62 EEGs contained epileptiform activity which assisted with an epilepsy diagnosis. Overall 22(29%) of 77 CT head scans disclosed abnormalities and 20(36%) of 56 in those with an index event of seizure. Brain tumours were identified in four patients or 5% of all patients who underwent CT scanning. All patients with an epilepsy diagnosis were offered follow up with a consultant neurologist and epilepsy nurse specialist. Late cancellation and non-attendence rates were 35-40% for initial clinic appointments and 16% for first seizure clinic review appointments. Conclusion: With provision of fast track, easy access first seizure services, individuals may be more likely to both attend and present earlier with fewer seizure events at first contact.