This document outlines a prospective cohort study to assess the risk of seizure recurrence after a first-ever seizure in adults. The study aims to test the hypothesis that the risk of seizure recurrence at 2 years is 50%, which is the mid-point of estimates from prior studies ranging from 29-71%. Adults presenting to the emergency department with suspected first-ever seizures will be referred to a first seizure clinic, provided a handout, and enrolled in the study if eligible. They will then be followed up as planned to track seizure recurrence rates and improve understanding of prognosis after a first seizure.

1. FIRST –EVER SEIZURE
STUDY
Dr Nicholas Lawn/ Dr Jacqui Saw

3. Seizure Protocol (FSH) – this says it all
actually

4. 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

6.  Flawed definition

8. 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.)

9. 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.

10. 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

11. 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

12. Good Reference