Proliferative retinopathy in a woman with growth hormone deficiency and diabetes mellitus.

In each of two years 1 2% of all patients referred as emergencies had had a seizure. One fifth of the patients who had just experienced their first fit were treated with an anticonvulsant drug. Current practice recommends starting treatment only after two or more seizures have been witnessed by someone else.4 Almost one fifth of the patients with first seizures were discharged immediately, some without an outpatient appointment. Just over half spent less than 48 hours in a short stay facility; a third were subsequently lost to follow up. Three fourths of those attending as outpatients were seen in a general medical clinic. The immediate care of patients who have a first seizure is important because over half can be expected to have a further seizurt within five years.> Early referral to a specialist will avoid a premature diagnosis of epilepsy and unnecessary treatment with anticonvulsant drugs. Regular review will prepare the patient for the diagnosis and ensure that suitabic treatment is started. Patients who present to our casualty department with a first fit are now reviewed urgently at our epilepsy clinic.