At-a-glance (first seizure, GP-friendly)
- Confirm what happened: obtain a witness account; consider syncope, arrhythmia, hypoglycaemia, and functional events.
- Urgent escalation: persistent altered consciousness, ongoing focal deficit, repeated seizures, pregnancy, head injury, or concern for CNS infection → emergency pathway.
- Refer: new suspected epilepsy generally needs specialist assessment; include key clinical details to reduce delays.
- Safety counselling: driving restrictions, water safety, heights, and occupational risk assessment are not optional.
What to capture (high-yield history + exam)
- Event description: prodrome, triggers, duration, motor features, tongue biting, incontinence, cyanosis, recovery time, injuries.
- Past history: head injury, CNS infection, stroke/TIA, alcohol/drug withdrawal, sleep deprivation.
- Medication list: agents that lower seizure threshold (and adherence issues).
- Basic checks: glucose, vitals, neuro exam, ECG if syncope possible.
Medication safety highlights (primary care awareness)
- Pregnancy-related precautions: NICE NG217 incorporates MHRA safety advice for antiepileptic drugs in pregnancy; be proactive about contraception and preconception planning.
- Valproate: major reproductive risk controls apply; initiation and ongoing use require strict safeguards and specialist involvement.
- Topiramate: pregnancy prevention safeguards apply in women of childbearing potential; follow current MHRA/NICE-linked advice and local prescribing governance.
- Never stop AEDs abruptly without specialist guidance; risk of withdrawal seizures/status.
Frequently asked questions
What are the most important safety counselling points after a suspected seizure?
Driving restrictions, water safety (bathing/swimming), heights, machinery, and occupational hazards. Document advice and provide written follow-up where possible.
What is the key medication safety issue to remember quickly?
Valproate and topiramate have major pregnancy-related safeguards; contraception and pregnancy planning must be addressed early, and specialist guidance is essential.
What should I include in the referral to speed things up?
Witness account summary, event timeline, recovery phase, injuries, neuro exam, glucose, ECG if relevant, meds/substances, and any red flags (pregnancy, recurrent events, focal deficits).
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.