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First seizure study SCGH


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First seizure study SCGH

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First seizure study SCGH

  1. 1. FIRST –EVER SEIZURE STUDY Dr Nicholas Lawn/ Dr Jacqui Saw
  2. 2. Seizure Protocol (FSH) – this says it all actually
  3. 3. Prognosis – risk of epilepsy  What do we tell our patients?  Whilst generally agreed that seizure recurrence is most likely within the first 6 months, estimates of the overall risk of recurrence vary widely, from 29 to 71% at 2 to 3 years3-9  Working number 40-50% at 2-3 yrs, 60-70% if epileptogenic lesion/remote symptomatic  Why is the range so wide?  Flawed follow up, most trials based on 1st seizure clinic data  Too long – waitlist 6 months in Perth  Time to ascertainment bias Patients who have a second seizure may go somewhere else Patients who don’t have a second event may just not turn up
  4. 4.  Flawed definition
  5. 5. Aim of the first-ever seizure project  Aims: To assess risk of recurrence after a first- ever seizure in adults.   Hypothesis: The risk of seizure recurrence at 2 years is 50% (i.e., the mid-point of prior studies’ upper and lower risk estimates.)
  6. 6. Method  Study type: Prospective cohort study of adults with first-ever seizure.   Participants: Adults (aged 18 years or over) with first-ever seizure. Patients with prior seizures or non-epileptic events that mimic seizures (eg convulsive syncope) will be excluded.
  7. 7. Patient presents with ?first seizure episode Clinical Assessment by ED physician Not a first seizure episode Patient is not given handout, no EDIS code allocated, not referred to clinic Likely first seizure episode Referred to First seizure Clinic Given first seizure handout Discharged home EDIS CODE ALLOCATED 24 hrs later PI accesses EDIS coding PI phones patient, confirms consent verbally Questionnaire completed PCIF mailed out Patient enrolled Yes, eligible for enrolment No, not eligible for enrolment Follow-up as planned in 1st seizure clinic No further contact with PI/AI Patient Enters study
  8. 8. How will this impact on ED?  EDIS coding  First seizure = D12755  Generalised tonic-clonic seizure = D00469  First Seizure handout – slightly different  See handout  Box with study mentioned on it
  9. 9. Good Reference