First Seizure

This condition is treated in the Neurology clinic.

Pre-referral work-up

History

All referrals should comply with referral standards. In particular:

• Witness description is the most important in clarifying the nature of the event (seizure vs convulsive syncope vs non-epileptic convulsive episode).
• Include features such as duration, truce tonic clonic/stiffening before the event; eyes open vs closed, rhythmic jerking vs irregular thrashing, and quick vs slow recovery.
• Ask the witness to co-attend the clinic appointment (or be available by phone) to help clarify what happened.
• Relevant risk factors which as head trauma, stroke, meningitis/encephalitis, prematurity and neonatal complications, febrile convulsions, family history
• Medications: Prescribed and others including alcohol, illicit drug use

For complex and chronic epilepsy please refer to Epilepsy Clinic

Tests

• CT or MRI brain
• EEG
• Na, Ca and glucose
• ECG
• Please ask witness of the event to attend clinic with the patient is possible (again, witness history is the most important – investigation")

Interim/GP management

To refer a patient with this condition, please see the Neurology clinic page for the full referral process and templates.

Develop a plan of emergency management in case of recurrence prior to clinic appointment.

Direct link to Health Pathways - First Seizures page

For more information please see the HealthPathways Tasmania website.

Seizures and Driving

Most patients who experience a first seizure don't require specialist review for assessment of fitness to drive, and most assessments can be completed by a general practitioner.

The guidelines are clear and are available in Assessing Fitness to Drive, 4th edition, produced by Austroads. This is available on the internet at www.austroads.com.au.

Specialist assessment is typically required for initial assessment for a commercial license, or when exceptional circumstances apply (i.e. if patient's condition or circumstances are not specifically covered by guidelines, or there is doubt about the patient's fitness to drive)

Neurophysiology, including EEG Referral template

For use by health professionals only

• Referral template - Medical Director
• Referral template - Best Practice

Other Links

• Epilepsy Tasmania

Clinic appointments

? Red location flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.

Emergency

? Persistent altered or worsening mental state in the postictal period

? Fever

? Recent trauma

? Persistent severe headache over 1hour post seizure

If you, or someone else, are experiencing a serious and life-threatening injury or illness call triple zero (000) immediately or go to the nearest Emergency Department.

Learn more about when to access emergency care and non-emergency care options if the injury or illness is not serious or life-threatening.

Urgent (Category 1)

? Persistent focal neurology on examination

? History of malignancy or immunosuppression

We will endeavour to see these patients within two weeks.

Urgent referrals should be accompanied by a phone call, as per below:

• Contact the Neurology Registrar directly within hours via the RHH switchboard Phone: (03) 6166 8308

Availability

North

Launceston General Hospital
Level 3 - Specialist Clinics

Phone: 1300 977 694
Fax: 03 6777 5227

North West

Unavailable.

South

Wellington Clinics
Phone: 03 6166 0000
Fax: 03 6173 0491