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Epilepsies — first seizure, safety, referral, and core principles

An evidence-bounded Australian page covering acute seizure care in Queensland, national driving standards and national TGA reproductive safety rather than claiming a comprehensive epilepsy CPG.

JurisdictionAustralia
Source check2026-08-20
Clinical reviewiatroX editorial team · Clinical editorial review · reviewed 2026-08-20 · due 2027-08-20
AudienceHealthcare professionals practising in Australia
This is an iatroX educational summary of named Australia sources, not an official guideline. It does not replace the complete source documents, local policy, specialist advice or clinical judgement. Acute seizure content is explicitly Queensland guidance. Driving uses Austroads plus the relevant state or territory licensing authority; long-term treatment requires specialist review.

Scope

Adults and children after a first suspected seizure, an acute convulsion or a breakthrough event. Queensland PCCM supplies the acute pathway; Austroads supplies national fitness-to-drive standards; TGA supplies pregnancy and reproductive-safety information for antiseizure medicines. No single current comprehensive Australian diagnosis and long-term treatment guideline was identified, so this page does not choose a maintenance medicine, dose or surgical pathway.
sources for this section:Queensland PCCM seizure pathwayAustroads fitness to driveTGA antiseizure-medicine pregnancy update

The Bottom Line

  • Obtain a witness account of onset, awareness, focal features, movements, duration, injury and recovery and consider syncope, arrhythmia, hypoglycaemia, intoxication, withdrawal, functional events and acute neurological disease.
  • During an active convulsion, protect airway and breathing, prevent injury, check glucose and follow the local time-critical seizure pathway; prolonged or repeated seizure without recovery is an emergency.
  • Arrange specialist assessment after a first unprovoked seizure or uncertain event. EEG and imaging are selected from the clinical question, and a normal EEG cannot independently exclude epilepsy.
  • Advise the person not to drive until assessed under the current Austroads standard and applicable licensing authority rules, documenting whether commercial, private and jurisdictional notification obligations differ.
  • Before conception or during pregnancy, do not abruptly stop antiseizure medicine; use current TGA reproductive-safety advice and urgent neurology and maternity review to balance seizure and fetal risks.
sources for this section:Queensland PCCM seizure pathwayAustroads fitness to driveTGA antiseizure-medicine pregnancy update

Practical clinical workflow

1
Stabilise the event, time seizure activity, check observations and glucose and assess for trauma, fever, meningism, pregnancy, toxic exposure and persistent focal or cognitive change.
2
Collect witness or video evidence where available and reconcile antiseizure medicines, last doses, recent changes, adherence, sleep, alcohol and interacting prescriptions.
3
Use the Queensland acute pathway only within its scope and transfer or retrieve when prolonged seizure, incomplete recovery or another emergency criterion is present; elsewhere use the local state service pathway.
4
For a stable patient, arrange timely neurologic evaluation and source-directed ECG, laboratory, EEG or imaging rather than starting or switching long-term therapy without classification.
5
Provide written safety advice for driving, water, heights, machinery, sleep and medication adherence and name who will review results, recurrence and reproductive planning.
sources for this section:Queensland PCCM seizure pathwayAustroads fitness to driveTGA antiseizure-medicine pregnancy update

Safety boundaries and escalation

  • A seizure lasting five minutes, repeated events without recovery, persistent focal deficit, major injury, pregnancy, CNS infection concern or reduced consciousness requires emergency care.
  • Do not place objects in the mouth, restrain convulsive movements or give oral medicine during impaired consciousness; position and support the airway when safe.
  • Stopping antiseizure medicine abruptly can provoke seizures, while some medicines carry substantial fetal risk; changes require specialist, product-specific and pregnancy-aware planning.
  • Breakthrough seizure may immediately change fitness to drive even when the person feels recovered; apply the current Austroads standard and notify the licensing authority when legally required.
sources for this section:Queensland PCCM seizure pathwayAustroads fitness to driveTGA antiseizure-medicine pregnancy update

Implementation

Queensland PCCM is a rural and remote Queensland acute-care source only. Austroads standards are national clinical standards, but licence action and mandatory or discretionary reporting are implemented by state and territory authorities. TGA reproductive warnings are national, while access to EEG, epilepsy services and emergency retrieval varies locally. No broader maintenance-treatment claims are made.
sources for this section:Queensland PCCM seizure pathwayAustroads fitness to driveTGA antiseizure-medicine pregnancy update

Clinical use boundary

This independently written summary is not an official guideline. Check the linked source version, current TGA-approved product information where medicines are involved, and the applicable state, territory and local pathway at the point of care.

sources for this section:Queensland PCCM seizure pathwayAustroads fitness to driveTGA antiseizure-medicine pregnancy update

Source documents

Use the linked source documents for complete recommendations, evidence grading, exclusions and implementation detail.

  1. Queensland Health and the Royal Flying Doctor Service Queensland SectionPrimary Clinical Care Manual, 12th edition: Fits/convulsions/seizures — adult/childISBN 978-1-876560-22-5 · 12th edition 2025, v1.03 with updates through July 2026 · accessed 2026-08-20
    view source
  2. Austroads and National Transport CommissionAssessing Fitness to Drive for commercial and private vehicle driversAP-G56-22; ISBN 978-1-922700-21-6 · Edition 6.0, 2022 · accessed 2026-08-20
    view source
  3. Therapeutic Goods AdministrationAntiepileptic medicines — updated precautions for pregnancy and women of childbearing potentialMedicine Safety Update published 22 June 2022; current status checked 2026-08-20 · accessed 2026-08-20
    view source
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