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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.

Exclude pregnancy. 

An EEG is only appropriate as a secondary care investigation, and imaging will depend on the likelihood of focal epilepsy.  
 

Referral:

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