A Community-Based Adult First Seizure Clinic: Experiences in the First Two Years.
Abstract number :
2.115
Submission category :
Year :
2001
Submission ID :
2701
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
D.F. Ghougassian, FRACP, Neurophysiology, Alfred Hospital, Melbourne, Victoria, Australia; T.J. O[ssquote]brien, MD, Neurology, St Vincents Hospital, Melbourne, Victoria, Australia; M.J. Cook, MD, Neurology, St Vincents Hospital, Melbourne, Victoria, Aust
RATIONALE: Data regarding the nature and implications of a first seizure are conflicting, reflecting differing case selection methods. [dsquote]First Seizures Clinics[dsquote] provide an opportunity to better study this issue, but have generally been established in tertiary epilepsy referral centres and are therefore subject to significant referral bias. We established a clinic for the assessment and further management of patients without an established diagnosis of epilepsy presenting to the Alfred Hospital Emergency Department (AHED) following a suspected seizure. As most patients who have a first seizure in the metropolitan catchment area of 200,000 are taken to the AHED, the experience of our clinic should be representative of that in the community.
Aim: To review the experience of the first two years of our clinic to determine the distribution of seizure diagnoses and the incidence of EEG and MRI abnormalities in adults presenting with a [dsquote]first seizure[dsquote].
METHODS: The demographics, clinical details, diagnosis and EEG/MRI results were reviewed for all patients referred to the clinic. All patients were personally seen by an epileptologist, and the majority had an EEG prior to the consultation.
RESULTS: Of 108 patients: an epileptic seizure was diagnosed in 81 (75%), a syncopal event in 11 (10%) and the diagnosis was uncertain in 16 (15%). In those who had an epileptic seizure, a careful history revealed a previous seizure in 52 (64%) [ndash] 16 (31%) of whom were diagnosed having a generalised epilepsy and 36 (69%) had a partial epilepsy, while in those with a true first seizures 4 (14%) had generalised epilepsy and 25 (86%) had partial epilepsy. Of the 94 who had an EEG performed, 73% were normal while 12% showed epileptiform changes. MR imaging was performed in 88, and was abnormal in 11 (12.5%).
CONCLUSIONS: Most patients presenting with a [dsquote]first seizure[dsquote] in adulthood have had previous seizures. Of those with a true first seizure, the vast majority are partial. MRI and EEG show abnormalities in only a minority of this group of patients.
Support: Dr Ghougassian was supported by an Epilepsy Fellowship Sponsored by Parke-Davis, Division of Pfizer.