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Journal of Epileptology

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Diagnoses and referral pattern at a first seizure clinic in London

Duncan Palka / Mahinda Yogarajah
  • Atkinson Morley Regional Neuroscience Centre, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
  • Institute of Medical and Biomedical Education, St George’s University of London, United Kingdom
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Hannah R. Cock
  • Atkinson Morley Regional Neuroscience Centre, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
  • Institute of Medical and Biomedical Education, St George’s University of London, United Kingdom
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Marco Mula
  • Corresponding author
  • Atkinson Morley Regional Neuroscience Centre, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
  • Institute of Medical and Biomedical Education, St George’s University of London, United Kingdom
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2018-02-06 | DOI: https://doi.org/10.1515/joepi-2017-0004

Summary

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.

Keywords: epilepsy; first unprovoked seizure

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About the article

Received: 2017-10-10

Accepted: 2017-10-18

Published Online: 2018-02-06

Published in Print: 2017-12-01


Citation Information: Journal of Epileptology, Volume 25, Issue 1-2, Pages 31–36, ISSN (Online) 2300-0147, DOI: https://doi.org/10.1515/joepi-2017-0004.

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© 2017 Duncan Palka et al., published by De Gruyter Open. This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License. BY-NC-ND 3.0

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