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Practitioner 2011; 255 (1743):25-28

Evaluating first seizures in adults in primary care

20 Sep 2011Pais-up subscribers

Many patients experiencing a first seizure will present to their GP. A seizure is defined as the clinical manifestation resulting from an excessive and abnormal discharge of a population of neurones. The individual lifetime risk of developing a non-febrile seizure is around 5% and approximately a third of patients will go on to experience further seizures and hence be diagnosed as having epilepsy. When evaluating a patient with a first seizure an accurate history is key and other potentially life-threatening diagnoses, especially cardiac disease, must be ruled out. Patients who have fully recovered should be directly referred to a first seizure clinic, where further tests and AEDs may be considered. Doctors should provide support and advice to the first seizure patient and be aware of the medical and social consequences of a diagnosis of seizures or epilepsy. Patients who have not recovered from their seizure, have an abnormal examination, or about whom there is diagnostic doubt, should be referred to the emergency department or specialist services for further investigations including brain imaging and lumbar puncture.

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