Is a separate clinical pathway for first seizures justified? Appraisal of the first seizure pathway at a tertiary neuroscience centre

ObjectivesTo investigate the clinical characteristics, final diagnosis, investigation results, management, response to anti-seizure medications (ASMs) and outcomes of individuals assessed in a First Seizure service over 5-year period.MethodsRetrospective analysis 772 who were clinically dedicated at National Hospital for Neurology & Neurosurgery (NHNN), Queen Square period.Results772 following suspected or reported first seizure (median age 54, average 39.4, range 16–96). 393 (50.9 %) ultimately diagnosed with definite which 183 (46.5 had experienced seizures previously not been recognised diagnosed. 250 (32 vasovagal syncope 69 (18.2 psychogenic non-epileptic seizures. EEGs 16.6 % unprovoked demonstrated epileptiform discharges, whilst 33.6 abnormal MRI findings felt be relevant.ConclusionsSeizure mimics represent significant proportion attendees ‘first seizure’ service. Improved recognition more education this issue could facilitate earlier management these other diagnostic entities ensure that only appropriate cases are referred Almost half previous seizures, highlighting importance obtaining relevant history reviewing ASM-naive timely manner primary aim preventing further recurrences.