• Experiencing a first seizure

It can be very alarming to patients when a first seizure happens. In the UK around 1 in 10 people will experience a single seizure in their lifetime. For many people, no obvious cause will be found, for others there may be an obvious provoking cause for example alcohol or drug misuse. However for 30% of patients an abnormality responsible for the seizure may be detected on a brain scan. For example a seizure can very often be the first indicator of a brain tumour and all patients with a first seizure will undergo Magnetic resonance (MRI) imaging. A first seizure may also be an indicator of an underlying predisposition to epilepsy and an electroencephalogram (EEG) may detect some changes to a persons brain waves. All patients presenting with a first seizure will be assessed for an underlying abnormal heart rhythm which may affect blood flow to the brain. Treatment is usually not needed following a single seizure unless a person is at risk of further seizures. A risk assessment is based on the investigation findings and where applicable, anti-epileptic medication may be advised. Patients will be advised to stop driving and inform the DVLA following a single seizure.

• What is epilepsy?

Epilepsy is one of the most common neurological conditions affecting around 70 million people world-wide. It is characterised by a tendency to experience unprovoked seizures, that is, more than one seizure, or, after a first seizure where there is a high chance of further seizures. Seizures can manifest in a number of ways from simple vacant spells to more serious convulsive attacks where the entire body can appear stiff and limbs may uncontrollably shake. Patients can stop breathing in convulsive attacks and may sustain injuries. Patients will often feel confused and tired following a seizure and may need to rest.

• What can cause epilepsy?

There are many causes of epilepsy and these can been broadly categorised into; genetic (inherited), structural brain lesions (for example a brain tumour), infectious (e.g. viruses), immune or in many patients the cause is unknown. Genetic epilepsies tend to present in childhood, whereas stroke disease is a more commonly found cause of epilepsy in older age groups.

Epilepsy can make you more likely to experience problems with mental health. For example, around one third of patients may suffer depression and a quarter of people may suffer anxiety. Many people also notice problems with memory and day to day functioning. This can make life difficult and can have a huge impact on employment, relationships and life enjoyment.

Premature death can occurs in epilepsy and may relate to injuries sustained during seizures, status epilepticus (uncontrollable prolonged seizures), suicide and SUDEP (Sudden Unexpected Death in EPilepsy). About 1 in a 1000 people with epilepsy die per year of SUDEP in the UK. The cause of SUDEP is unknown, but 9 in 10 people are found in a prone position with signs suggestive of a recent seizure.

It is therefore paramount that seizures are controlled in epilepsy in preventing SUDEP and ensuring a good quality of life.

• How is epilepsy diagnosed?

Epilepsy is a clinical diagnosis based on witness accounts or videos of events. Epilepsy can sometimes be difficult to diagnose particularly if patients have experienced unwitnessed events or details are limited. Faints, blackouts related to heart problems and non-epileptic attack disorder (NEAD) are conditions that require distinction from epileptic seizures. Patients will usually undergo a heart trace (ECG), and where applicable a brain wave test (EEG; electroencephalogram) and Brain scan (MRI; Magnetic resonance imaging). Specialised genetic tests may also be requested where a family history of epilepsy is known or where there are other clincial indicators of an underlying genetic disorder. Some patients may require further tests for example Videotelemetry (VT), PET (Positron Emission Tomography) depending on whether there are diagnostic uncertainties or the patient is being considered for surgery.

• How is epilepsy treated?

Most patients require anti-epileptic drug treatment to control seizures. Around 70% achieve seizure control with one or two trials of appropriately chosen drug treatment. Around one third remain uncontrolled requiring further additions or adjustment to their therapeutic regime. Important considerations and counselling is required when discussing treatment for epilepsy particularly around side effects and risk exposures in women of child bearing age. There are several specialised treatments for certain epilepsy syndromes. These include cannabidiol for Dravet syndrome and Lennox-Gastaut syndrome, stiripentol in Dravet Syndrome, Fenfluramine in Dravet Syndrome, Everolimus in tuberous sclerosis epilepsy and rufinamide in Lennox-Gastaut syndrome. These drugs require initiation and monitoring by a specialist working within a recognised tertiary epilepsy centre.

Some patients particularly those with a structural brain lesion may be considered for epilepsy surgery or a neurostimulator device (VNS; Vagus nerve stimulator). Surgery offers a chance of achieving a cure for epilepsy with around two thirds remaining seizure free for 10 years after surgery. A VNS is a pulse generator which is fitted under the skin in the left side of the chest with electrodes tethered to the vagus nerve in the neck. Studies report that around 60% of people reduce their seizures by 50% 5 years after implantation in addition to improvements in mood and alertness.

• Why it is important to seek our help?

Seeking our help may offer the best chance of controlling seizures, minimising risks and improving overall quality of life. Many patients with epilepsy experience unacceptable stigma around the condition which can affect the ability of a person to live out their dreams. By having expert assessment and care we aim to keep people safe and maximise their potential.

• Medicolegal services

We currently do not provide consultations or medical reports for medicolegal purposes or offer expert witness services.