Document type
Clinical pathways
Hertfordshire and West Essex ICB
Output type
Clinical Pathways
GP First Seizure Pathway | Adults

Epilepsy, Fits and Seizures

Pathway Publish Date: July 2023
Pathway Next Review Date: July 2025 

NB: Red flags should be referred to the emergency department and any other suspected first fit should be seen by neurology within 2 weeks, details below:

For a patient that presents with a first seizure (witnessed/unwitnessed):

  1. Establish the likelihood of the seizure incorporating a detailed history from the patient and witness (including any videos)
  2. Conduct a full medical examination to assess for the causes of seizure
  3. Determine if there are any red flags:
    •  GCS persistently <15
    •  Focal Neurological signs/deficit
    •  Sudden onset headache
    •  Head injury
    •  Signs of Meningitis or encephalitis
    •  Signs of raised intra-cranial pressure
    •  Headache associated with seizures
    •  Pregnancy/post-partum
    •  Features suggestive of Pregnancy induced Hypertension
    •  History of malignancy
    •  Patients on anti-coagulants
    •  Chronic alcoholic
    •  Prolonged seizure

If any red flags present:

  1. Refer the patient to the emergency department for an urgent CT/MRI head

If there are no red flags present:

This could represent a presumed first seizure

Presuming the patient is now clinically stable arrange appropriate investigations (see pathway) and make a referral at the same time (do not delay referral while waiting for test results)


    Patient to be referred to urgent neurology clinic (to be seen within 2/52).  Referral via eRS to be made at the time by GP seeing the patient

Provide appropriate advice to the patient including:

  • Provide CCG advice sheet and signpost to websites for further information
  • Counsel the patient on:
  • Stop driving and inform DVLA
  • Avoid swimming and bath with someone else in the house/door open
  • Not to operate heavy machinery

Safety net:

  • Advise patient and family on what to do if further seizures occur and when to call an ambulance (on front page)