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First Seizure Clinic

Checked: 11-03-2025 by Rob Adams Next Review: 11-03-2027

Overview

****UPDATE (March 2025)- current waits for first seizure clinic are 5-6 months due to increasing volume of referrals. The service is currently recruiting additional clinical capacity to address this back log. All referrals will be triaged by a consultant neurologist and patients will be seen more quickly if clinically indicated.

If a referrer is worried about a particular patient and wishes to expedite a referral then please email the neurology secretary team (nbtneurologysecretaries@nbt.nhs.uk)detailing the reasons why this is felt to be necessary.

If same day advice is needed please consider the Neurology Telephone Advice line for GPs - details are on the Advice & Guidance - Neurology/HOT Clinic page. *****

This First Seizure Clinic is run by the Neurology department at NBT. The clinic is run by consultant neurologists with specialist training in Epilepsy with support from Epilepsy Specialist Nurses. The clinic endeavours to see patients within 2 weeks (however - see update on wait times above). Please note this is not a syncope or dizzy clinic and in order to see patients with first seizures rapidly they will unfortunately have to reject such referrals.

Who to Refer

To refer to the first seizure clinic , patients must fulfil ALL of these criteria:

Above 16 years old (see the Fits, Faints and Funny Turns page for children aged under 16 years).
New onset seizures or blackouts (Syncope should not be referred)
Patient has made a full recovery from event
Not under a neurologist for seizures/blackouts (please refer back to the team involved)
Patient information sheet given out

Please note this is not a syncope or dizziness clinic.

In these cases please consider the following options for your patient which may be more appropriate:

Red Flags

Suspected Malignancy

Patients who have had a seizure and any of the following red flags should be referred using the Brain & CNS - USC (2WW) pathway:

New and / or progressive neurological deficit, with or without cranial nerve palsies (please note that deafness alone cannot be defined as a neurological deficit)
Headaches with other features of raised intracranial pressure (ICP), such as headache worse on waking, associated with vomiting, with or without papilloedema
Previous history of cancer with unresolved headaches

Before Referral

See Assessment | Epilepsy | CKS for details on assessing a patient who has had a suspected seizure.

Please provide a detailed history of the circumstances leading to, and description of the suspected seizure (including witness information if possible).

Undertake a neurological examination to exclude red flags (see above)

The following suggested investigations should be undertaken (but should not delay referral):

Blood tests – FBC, U and E, LFT, Mg, Ca.
ECG (if abnormal then consider cardiology assessment or advice and guidance initially)

Include results of any brain imaging if undertaken.

Referral

Referrals should be made using the First Seizure Clinic referral form (available as and EMIS template) and submitted via e-RS.

The Patient Information Sheet (word doc) should to be given to the patient.

Please also warn patients regarding driving while they are waiting to be seen - see resources section below.

Please note - patients with an established history of epilepsy should be referred to the general epilepsy clinics and not the first seizure clinic.

Resources

References

(1) Epilepsy | Health topics A to Z | CKS | NICE

Driving Advice

DVLA guidelines for clinicians: Neurological disorders: assessing fitness to drive - GOV.UK (www.gov.uk)
DVLA guidelines for patients: Epilepsy and driving - GOV.UK (www.gov.uk)

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.