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CDHB

Epilepsy: Patients Presenting with New Possible or Definite Seizures

Diagnosis

The common differential diagnoses are convulsive syncope, cardiac syncope and psychogenic seizure. The diagnosis is based on the patient and eyewitness descriptions of the attack. Attack descriptions must be documented in detail, as they may not be available later and they are the main information on which the diagnosis is based. Do not simply document your own (or someone else’s) opinion of what the attack is.

Potential Causes

• Document any history of potential causative factors.
• Document the results of neurological examination.
• If definite or probable seizure(s), request outpatient CT.

Management

• If the patient is alert and well:
  • No acute medical management is necessary.
  • Advise the patient that NZTA requires them not to drive for one year. Document this advice in the notes and in any referral.

    Note: On receipt of a report from a neurologist, NZTA may allow driving in some low risk patients with single seizure if there is no recurrence after 6 months.

  • Advise against high risk activities (swimming alone, working at heights etc.).
  • Give first aid seizure management advice.
  • Discharge:
    • If the patient has had a single seizure, refer to Neurology outpatients only if the diagnosis is uncertain. Advise patient and GP that referral to Neurology will be necessary if the seizure recurs. Do not commence anticonvulsant treatment.
    • If the patient has had more than one seizure, refer to Neurology. Do not commence anticonvulsant treatment unless you feel the patient is at risk, in which case contact the Neurology Registrar.
    • If seizure(s) are due to alcohol, do not refer to Neurology. Request CT and advise not to drive for 1 year.
• If recovery is delayed, with prolonged drowsiness, or coma, or there is an acute or subacute onset neurological deficit:
  • Request urgent CT.
  • Contact the Neurology Registrar for consideration of admission and/or further assessment.

Topic Code: 1522