Newly diagnosed seizures assessed at two established first seizure clinics: Clinic characteristics, investigations, and findings over 11 years

• Published in: Epilepsia open Vol. 6; no. 1; pp. 171 - 180
• Main Authors: McIntosh, Anne M., Tan, K. Meng, Hakami, Tahir M., Newton, Mark R., Carney, Patrick W., Yang, Mengjiazhi, Saya, Sibel, Marco, David J. T., Perucca, Piero, Kwan, Patrick, O’Brien, Terence J., Berkovic, Samuel F.
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01-03-2021; John Wiley and Sons Inc; Wiley
• Subjects: Adult; Ambulatory Care Facilities - organization & administration; Ambulatory Care Facilities - standards; Australia; Brain research; Central business districts; Clinics; Convulsions & seizures; EEG; Electroencephalography; Epilepsy; Epilepsy - diagnosis; epileptogenic lesion; Female; Full‐length Original Research; Humans; imaging; Male; new‐onset; Outpatients - statistics & numerical data; Patients; Seizures - diagnosis; Sleep; Stroke; Australia; epilepsy; imaging; EEG; epileptogenic lesion; new‐onset
• ISSN: 2470-9239; 2470-9239
• DOI: 10.1002/epi4.12460

Objective
‘First seizure’ clinics (FSCs) aim to achieve early expert assessment for individuals with possible new‐onset epilepsy. These clinics also have substantial potential for research into epilepsy evolution, outcomes, and costs. However, a paucity of FSCs details has implications for interpretation and utilization of this research.
Methods
We reviewed investigation findings over 11 years (2000‐2010) from two established independent FSCs at Austin Health (AH) and Royal Melbourne Hospital (RMH), Australia. These adult clinics are in major public hospitals and operate with similar levels of expertise. Organizational differences include screening and dedicated administration at AH. Included were N = 1555 patients diagnosed with new‐onset unprovoked seizures/epilepsy (AH n = 901, RMH n = 654). Protocol‐driven interviews and investigations had been recorded prospectively and were extracted from medical records for study.
Results
Median patient age was 37 (IQR 26‐52, range 18‐94) years (AH 34 vs RMH 42 years; P < .001). Eighty‐six percent of patients attended FSC within three weeks postindex seizure (median AH 12 vs RMH 25 days; P < .01). By their first appointment, 42% had experienced ≥2 seizures. An EEG was obtained within three weeks postindex seizure in 73% of patients, demonstrating epileptiform discharges in 25% (AH 33% vs RMH 15%). Seventy‐six percent of patients had an MRI within 6 weeks. Of those with imaging (n = 1500), 19% had potentially epileptogenic abnormalities (RMH 28% vs AH 12%; P < .01). At both sites, changes due to previous stroke/hemorrhage were the commonest lesions, followed by traumatic brain injury. ≥WHO level 1 brain tumors diagnosed at presentation comprised a very small proportion (<1%) at each clinic. At both sites, epilepsy type could be determined in 60% of patients; RMH had more focal and AH more generalized epilepsy diagnoses.
Significance
Differences between the clinics’ administrative and screening practices may contribute to differences in investigation findings. Insight into these differences will facilitate interpretation and utilization, and planning of future research.