Dr Eileen Mc Manus is an Advanced Trainee in Neurology working at Waikato General Hospital, Hamilton, New Zealand. She was born and trained in Ireland, gaining both MBChB and Neuroscience MSc from Trinity College Dublin 2013. She moved to New Zealand in 2015, working first in Thames Hospital and then Waikato General Hospital. In her spare time, she is an avid hiker and loves the outdoors including landscape photography.
Long Term Outcome of 200 Patients Referred to A First Seizure Clinic
1) To determine what proportion of our first seizure referrals reflected true unprovoked first seizures or epilepsy, 2) To assess the diagnostic accuracy of our First Seizure Clinic by quantifying risk of subsequent seizures in our First Seizure Clinic cohort.
We retrospectively reviewed the medical records of 200 patients referred to the First Seizure Clinic between May 2014 and December 2015, with review of clinical notes and telephone follow up at 28 months post diagnosis.
Of the 200 patients referred to the first seizure clinic, 181 attended. At the initial assessment 22% (n=39) of these patients were diagnosed with epilepsy, with most of these patients (59%) found to have a history of previous seizures. 28% (n=50) were diagnosed with a first seizure, of which 28% were labelled as provoked seizures. 38% (n=69) of the patients received another diagnosis (syncope, NEAD, migraine or parasomnia) and 13% (n=23) were labelled as indeterminable. At 28 months follow up, 22% (n=11) of patients who received a diagnosis of first seizure subsequently received a diagnosis of epilepsy. In the remaining groups only 5 (5%) patients were diagnosed with epilepsy (of these 3 were in the indeterminable group).
Our study shows that approximately half of the patients referred to a First Seizure Clinic had not experienced a seizure but were given an alternative diagnosis. Secondly, our study indicates that the risk of seizure reoccurrence following a first seizure is quite low (22%). We believe this because a substantial proportion of the patients (22%) were diagnosed with epilepsy already at the first assessment. The high proportion of patients being diagnosed with epilepsy was mainly due to a history of previous seizures. Thirdly, patients who were given an alternative diagnosis at the first assessment had a low probability (5%) for seizure recurrence.