FIRST –EVER SEIZURE STUDY

Dr Nicholas Lawn/ Dr Jacqui Saw

Seizure Protocol (FSH) – this says it all actually

Prognosis – risk of epilepsy

What do we tell our patients? Whilst generally agreed that seizure recurrence is

most likely within the first 6 months, estimates of the overall risk of recurrence vary widely, from 29 to 71% at 2 to 3 years3-9

Working number 40-50% at 2-3 yrs, 60-70% if epileptogenic lesion/remote symptomatic

Why is the range so wide? Flawed follow up, most trials based on 1st seizure

clinic data Too long – waitlist 6 months in Perth Time to ascertainment bias

Patients who have a second seizure may go

somewhere else

Patients who don’t have a second event may just not

turn up

Flawed definition

Aim of the first-ever seizure project

Aims: To assess risk of recurrence after a first-ever seizure in adults.

  Hypothesis: The risk of seizure

recurrence at 2 years is 50% (i.e., the mid-point of prior studies’ upper and lower risk estimates.)

Method Study type: Prospective cohort study of

adults with first-ever seizure.   Participants: Adults (aged 18 years or

over) with first-ever seizure. Patients with prior seizures or non-epileptic events that mimic seizures (eg convulsive syncope) will be excluded.

Patient presents with ?first seizure episode

Clinical Assessment by ED physician

Not a first seizure episode Patient is not given handout, no EDIS code allocated, not referred

to clinic

Likely first seizure episode

Referred to First seizure Clinic

Given first seizure handout

Discharged home EDIS CODE ALLOCATED

24 hrs

later

PI accesses EDIS coding

PI phones patient, confirms consent verbally

Questionnaire completed

PCIF mailed out

Patient enrolled

Yes, eligible for enrolment

No, not eligible for enrolment

Follow-up as planned in 1st seizure clinic

No further contact with PI/AI

Patient Enters study

How will this impact on ED? EDIS coding

First seizure = D12755 Generalised tonic-clonic seizure = D00469

First Seizure handout – slightly different See handout Box with study mentioned on it

Good Reference