Blackout / Epilepsy / Transient of Consciousness
First seizure will usually have been assessed acutely in A&E. (25% refer from GP), who will normally have referred directly to Neurology.
History of episode important: What happened, when, possible triggers. Witness history most important, so please ask a witness to attend the appointment, or provide a written account.
Neurological examination is usually unhelpful if there are no symptoms to suggest an underlying structural problem, but a cardiac assessment is useful to exclude a conduction problem.
Hypoglycaemia, hypoxia and trauma/concussion can cause a seizure in people who do not have epilepsy and may not always need neurological investigation.
Investigations: ECG (For QTc interval if referrer suspects arrhythmia)
Glucose,FBC,EUC,LFTs,Ca,Mg,ESR only help if clinically indicated.
An EEG is only appropriate as a secondary care investigation, and imaging will depend on the likelihood of focal epilepsy.
From primary care, referral to neurology is required if seizure suspected, and inform patient of driving regulations and safety issues. The patient may be triaged to a first blackout clinic.
Syncope, cardiac cause, panic/hyperventilation do not need Neurological referral. However cardiac syncope should be referred to cardiology.
If a tumour is suspected please request an urgent MRI and if confirmatory, assuming the patient is not already known to oncology, direct referral to the Derriford Neuro-oncology MDT will save time.
The epilepsy nurse is available on 01872 253088