Refining first seizure management – can an epilepsy nurse impact outcomes?

Background/Objectives
People referred to First Seizure Clinics (FSCs) often face long waiting times. Many have seizure mimics. This study aimed to evaluate the impact of an epilepsy nurse (EN) in reducing wait times and minimising seizure mimic referrals. We also aimed to illustrate the range of seizure mimics referred to the FSC and describe diagnostic revisions over time.

Methods
We prospectively collected data from a hundred consecutive individuals seen in FSCs at our centre before and after introduction of a new part-time EN and followed up for a minimum 12 months. Key outcomes included diagnostic revisions over time, changes in referral patterns, characteristics of seizure mimics, and time elapsed between referral and FSC appointment.

Results
Patients (50 male, 50 female) had a median age of 41.4 (range 18–90) years. Fifteen (15%) people had an abnormal MRI and 33% had an abnormal EEG, including eleven (11%) with epileptiform abnormalities. Seizure mimics accounted for 29/50 (58%) diagnoses before the commencement of an epilepsy nurse and reduced to 19/50 (38%) after epilepsy nurse commencement (p<0.05). There was no significant reduction in clinic wait-time post-EN (relative reduction in median wait-time of 39%, p = 0.41). Common seizure mimics included syncope (18%) and PNES (8%). Twelve people (8 pre-EN, 4 post-EN) had a diagnostic change to Epilepsy over the next 12 months after FSC.

Conclusion
An EN improved performance of our FSC however wait times remained outside best practice recommendations. Seizure mimics accounted for many FSC referrals and better methods of identifying these are required.