Diagnoses and referral pattern at a first seizure clinic in London

Abstract

SUMMARYBackground. Epilepsy is among the most frequent neurological conditions and it is estimated that approximately 8% of the population experience a seizure at some time in their lives. Aim. To examine the characteristics of patients referred to a First Seizure Clinic (FSC) at a University Hospital in South-West London. Methods. All subjects referred to the FSC at St George's University Hospitals between January and December 2015 were included in this audit. Results. From a total of 257 patients, males 49.5%, age range 16-90, 30% referred by General Practices (GPs), 59.1% by the Accident & Emergency Department (A&E) and 10.9% by other hospital wards, 24.5% did not attend (DNA) the clinical appointment. Females who did not attend were significantly older than males (49.8 years old vs 39.7; p = 0.007). Among those who attended the clinical appointment, 17% were diagnosed first unprovoked seizure, 12.4% acute symptomatic seizure and 28.9% epilepsy. These patients were referred mainly by A&E while GPs referred seizure mimics especially non-epileptic attack disorder (NEAD) and syncope. Patients with NEAD were significantly younger than those with seizures (29.4 years old vs 44.2; p < 0.001) and had a previous psychiatric history (72.7% vs 16.8%; p < 0.001). The proportion of seizure mimics was similar in the older sample group (> 65 years). Regarding acute symptomatic seizures, 33.3% were alcohol-related, 20.8% acute brain insults and 12.5% drug-related (always overdose). Conclusions. 1 in 4 patients referred to a FSC does not attend the clinical appointment, especially older females. More than 1 in 3 cases represent seizure mimics and are referred mainly by GPs.

Early Access to First-Seizure Clinics, Subsequent Outcomes, and Factors Associated With Attendance

“…We found that patients admitted for less than 1 day at the time of FSC referral (ie, patients who had only a brief ED stay and were not admitted or were referred to FSC from the community) had higher risk of a missed appointment. This contrasts with previous research, which has not demonstrated an association between missed FSC appointment and source of referral . Patients who had briefer contact with the health system at the time of referral may have had reduced opportunities for patient education, arranging investigations, or commencing treatment, and therefore, it is concerning that these patients were more likely to fail to attend FSC.…”

Evaluation of electroencephalographic changes in patients with the new onset suspicious seizure movements

“…Seizure is defined as excessive or concurrent simulation and abnormal activity of neurons in the brain and is classified into three general categories of focal seizures, generalized seizures and non-classified seizures. 1 The incidence rate of seizures in high-income countries is between 40 and 70 cases per 100,000 people per year and in less developed countries it is estimated to be about twice that rate which is usually higher among young children and older people. 2 The new onset seizure can range from a fleeting experience such as twitch to a toniccolonic seizure.…”