This page covers the referral and assessment process for children, young people and adults. The information reflects current NICE guidelines.
When someone has their first suspected epileptic seizure, they need to be seen quickly for assessment and diagnosis.
There’s also guidance for parents on what they can do to help their child’s assessment, and information on conditions that can be mistaken for epilepsy.
First suspected seizure – what happens?
If a child, young person or adult has a first suspected seizure, it’s likely that they’ll be taken to the nearest Accident and Emergency department or, in some cases, seen by their GP.
If a doctor thinks they’ve had an epileptic seizure, they’ll arrange an urgent appointment with an epilepsy specialist for assessment and diagnosis.
The appointment should, ideally, be within two weeks, but it may take a little longer.
Information and support after first suspected seizure
After the first suspected seizure, the adult, young person or child, and parents and carers, as appropriate, should get information about:
- How to recognise a further seizure
- First aid and initial safety guidance in case of another seizure
- Changes they can make to reduce the risk of having another seizure
- Who to contact if they have another seizure while waiting for their appointment for assessment and diagnosis – this information could be on a website or a leaflet
If a child’s first suspected seizure is afebrile (without fever), parents and carers should be told how to refer their child urgently if they have another seizure.
Referral after first suspected seizure
After a first suspected seizure, children, young people and adults will be referred urgently for an assessment within two weeks.
Adults should be referred to a clinician with expertise in assessing first seizures and diagnosing epilepsy.
Children and young people should be referred to a paediatrician (children’s doctor) with expertise in assessing first seizures and a special interest in epilepsy.
For children under two years of age, with suspected or confirmed infantile spasms, see Infantile spasms.
Assessing the risk of a second seizure
At the appointment after a first suspected seizure, children, young people and adults will be assessed for their risk of having a second seizure.
Assessment will include:
- A detailed medical history, from the child, young parents, parents and carers, as appropriate, or adult
- A physical examination
- Eyewitness accounts and, if possible, video footage of the suspected seizure, as this will help the epilepsy expert to make a proper assessment
A 12-lead electrocardiogram (ECG) test to see if there are any cardiac (heart) problems that could be mistaken for an epileptic seizure
Children whose first seizure is afebrile (without a fever) are more at risk of further afebrile seizures, especially within 6–12 months, than children who have a febrile seizure (seizure with a fever).
Children whose first seizure is a complicated febrile seizure – lasting longer than 10 minutes or with other features, such as weakness on one side of the body – may be more at risk of epilepsy, especially if they have other risk factors for epilepsy.
For adults, assessment should include checking for the following risk factors:
- Underlying mental health problems, e.g. depression, anxiety, psychosis (unable to tell what’s real and what’s not) and alcohol or drug problems
- Vascular problems, e.g. diabetes (hypoglycaemia/low blood sugar can also cause seizures), hypertension (high blood pressure) or atrial fibrillation (abnormal heart rhythm)
- Sepsis (blood poisoning)
If the child or young person’s medical history and examination suggests an epileptic seizure, they may be referred for an electroencephalogram (EEG).
If it’s suspected there’s an underlying structural cause of their seizure, they may be referred for neuroimaging (brain scans).
At the assessment, the young person, adult or child, and parents and carers, as appropriate, should also get information about their individual risk for more seizures.
This should include any mental, physical or social factors, with information on changes they can make to manage and reduce these risks.
Referral after remission
If a child, young person or adult has a period of remission (no seizures) and then another seizure, they should be referred urgently for an assessment within two weeks.
