Document type

Clinical pathways

Place

Hertfordshire and West Essex ICB

Output type

Clinical Pathways

Pathway

GP First Seizure Pathway | Adults

Epilepsy, Fits and Seizures

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)

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  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)