Background. Epilepsy is among the most frequent neurological conditions and it is estimated that approximately 8% of the population experience a seizure at some time in their lives.
Aim. To examine the characteristics of patients referred to a First Seizure Clinic (FSC) at a University Hospital in South-West London.
Methods. All subjects referred to the FSC at St George’s University Hospitals between January and December 2015 were included in this audit.
Results. From a total of 257 patients, males 49.5%, age range 16–90, 30% referred by General Practices (GPs), 59.1% by the Accident & Emergency Department (A&E) and 10.9% by other hospital wards, 24.5% did not attend (DNA) the clinical appointment. Females who did not attend were significantly older than males (49.8 years old vs 39.7; p = 0.007). Among those who attended the clinical appointment, 17% were diagnosed first unprovoked seizure, 12.4% acute symptomatic seizure and 28.9% epilepsy. These patients were referred mainly by A&E while GPs referred seizure mimics especially non-epileptic attack disorder (NEAD) and syncope. Patients with NEAD were significantly younger than those with seizures (29.4 years old vs 44.2; p < 0.001) and had a previous psychiatric history (72.7% vs 16.8%; p < 0.001). The proportion of seizure mimics was similar in the older sample group (> 65 years). Regarding acute symptomatic seizures, 33.3% were alcohol-related, 20.8% acute brain insults and 12.5% drug-related (always overdose).
Conclusions. 1 in 4 patients referred to a FSC does not attend the clinical appointment, especially older females. More than 1 in 3 cases represent seizure mimics and are referred mainly by GPs.
Beghi E., Carpio A., Forsgren L., Hesdorffer D.C., Malmgren K., Sander J.W. et al.: Recommendation for a definition of acute symptomatic seizure. Epilepsia, 2010, 51: 671–675. doi: 10.1111/j.1528-1167.2009.02285.x
Boer H.M. de, Mula M., Sander J.W.: The global burden and stigma of epilepsy. Epilepsy Behav., 2008, 12: 540–546. doi: 10.1016/j.yebeh.2007.12.019
Carson A., Lehn A., Ludwig L., Stone J.: Explaining functional disorders in the neurology clinic: a photo story. Pract. Neurol., 2016, 16: 56–61. doi: 10.1136/practneurol-2015-001242
Covanis A., Guekht A., Li S., Secco M., Shakir R., Perucca E.: From global campaign to global commitment: The World Health Assembly’s Resolution on epilepsy. Epilepsia, 2015, 56: 1651–1657. doi: 10.1111/epi.13192
Duncan J.S., Sander J.W., Sisodiya S.M., Walker M.C.: Adult epilepsy. Lancet, 2006, 367: 1087–1100. doi: 10.1016/S0140-6736(06)68477-8
Firkin A.L., Marco D.J.T., Saya S., Newton M.R., O’Brien T.J., Berkovic S.F., McIntosh A.M.: Mind the gap: Multiple events and lengthy delays before presentation with a ‘first seizure’. Epilepsia, 2015, 56: 1534–1541. doi: 10.1111/epi.13127
Fisher R.S., Acevedo C., Arzimanoglou A., Bogacz A., Cross J.H., Elger C.E. et al.: ILAE Official Report: A practical clinical definition of epilepsy. Epilepsia, 2014, 55: 475–482. doi: 10.1111/epi.12550
Hauser W.A., Kurland L.T.: The epidemiology of epilepsy in Rochester, Minnesota, 1935 through 1967. Epilepsia, 1975, 16: 1–66.
Hesdorffer D.C., Hauser W.A., Olafsson E., Ludvigsson P., Kjartansson O.: Depression and suicide attempt as risk factors for incident unprovoked seizures. Ann. Neurol., 2006, 59: 35–41. doi: 10.1002/ana.20685
Hindley D., Ali A., Robson C.: Diagnoses made in a secondary care “fits, faints, and funny turns” clinic. Arch. Dis. Child., 2006, 91: 214–218. doi: 10.1136/adc.2004.062455
MacDonald B.K., Cockerell O.C., Sander J.W., Shorvon S.D.: The incidence and lifetime prevalence of neurological disorders in a prospective community-based study in the UK. Brain, 2000, 123: 665–676. doi: 10.1093/brain/123.4.665
Mellers J.D.C.: The approach to patients with ‘non-epileptic seizures’. Postgrad. Med. J., 2005, 81: 498–504. doi: 10.1136/pgmj.2004.029785
Mula M., Sander J.W.: Psychosocial aspects of epilepsy: a wider approach. Br. J. Psychiatry Open, 2016, 2: 270–274. doi: 10.1192/bjpo.bp.115.002345
NICE (The National Institute for Health and Care Excellence): Epilepsies: diagnosis and treatment. Clinical guideline [CG137], 2012. www.nice.org.uk/guidance/cg137
Pohlmann-Eden B., Aldenkamp A., Baker G.A., Brandt C., Cendes F., Coras R. et al.: The relevance of neuropsychiatric symptoms and cognitive problems in new-onset epilepsy – Current knowledge and understanding. Epilepsy Behav., 2015, 51: 199–209. doi:10.1016/j.yebeh.2015.07.005
Rizvi S., Hernandez-Ronquillo L., Moien-Afshari F., Hunter G., Waterhouse K., Dash D., Téllez-Zenteno, J.F.: Evaluating the single seizure clinic model: Findings from a Canadian Center. J. Neurol. Sci., 2016, 367: 203–210. doi: 10.1016/j.jns.2016.05.060
Scheepers B., Clough P., Pickles C.: The misdiagnosis of epilepsy: findings of a population study. Seizure, 1998, 7: 403–406.
Smith D., Defalla B.A., Chadwick D.W.: The misdiagnosis of epilepsy and the management of refractory epilepsy in a specialist clinic. QJM Mon. J. Assoc. Physicians, 1999, 92: 15–23.