Diagnoses and referral pattern at a first seizure clinic in London


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Journal of Epileptology

Foundation of Epileptology

Subject: Medicine


eISSN: 2300-0147





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VOLUME 25 , ISSUE 1-2 (December 2017) > List of articles

Diagnoses and referral pattern at a first seizure clinic in London

Duncan Palka / Mahinda Yogarajah / Hannah R. Cock / Marco Mula *

Keywords : epilepsy, first unprovoked seizure

Citation Information : Journal of Epileptology. Volume 25, Issue 1-2, Pages 31-36, DOI: https://doi.org/10.1515/joepi-2017-0004

License : (CC BY 4.0)

Received Date : 10-October-2017 / Accepted: 18-October-2017 / Published Online: 14-November-2017



Background. 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.

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