Seizures are the most common pediatric neurological disorder. Four to ten percent of children suffer at least one seizure in the first 16 years of life. The incidence is highest in children less than three years of age, with a decreasing frequency in older children. Some people with a first seizure will eventually go on to have additional seizures and be diagnosed with epilepsy. Thus, the occurrence of a single seizure in childhood deserves careful consideration. First of all, a distinction should be made between provoked and unprovoked seizures, since this has implications for treatment and prognosis, such as the risk of developing epilepsy. Provoked seizures are those events that result from some immediately recognizable stimulus or cause. Examples of such causes include hypoglycemia from excessive insulin in diabetic patients or fever in patients with febrile seizures. Provoked seizures may recur whenever the precipitating situation is present, but do not happen at other times in absence of the stimulus and thus do not constitute epilepsy. In contrast, unprovoked seizures do not require an immediate precipitating event. The occurrence of an unprovoked seizure suggests the possibility of an underlying neurological disorder that may predispose a child to recurrent seizures.

The aim of the First Seizure Clinic is to receive patients who may have had an epileptic seizure for the first time or for whom a diagnosis of epilepsy is suspected. An urgent referral pathway has been established to avoid the usual delays in assessment and counseling for people in this situation where there is often a significant impact on their psychological and social health.

The referrals are made from local pediatricians and family physicians. The division of pediatric neurology then arranges an EEG if deemed necessary. At that time, an appointment for the Clinic is made and we aim to see patients within two weeks of the suspected seizure. 

The evaluation of the first unprovoked seizure shall address several questions:

1. Is this a seizure or some other paroxysmal event? A Canadian study has reported that diagnostic inaccuracy is common in first seizure. One quarter of children were incorrectly diagnosed as having a seizure while the diagnosis of epilepsy was missed in over one-third of children (Epilepsia. 2007; 48:1062-6).
2. Is this the first seizure?
3. What are the characteristics of the seizure and does it represent a sign of a known syndrome or disease?
4. How extensive should the evaluation be?
5. Does the child need treatment with antiepileptic drugs (AEDs)?
6. What is the risk of recurrence and long-term prognosis?

The modern approach to epilepsy relies heavily on electro clinical syndromic classification of individuals' seizure disorders. In modern practice, however, the syndromic approach is rarely applied to "first seizures", in part, because patients seldom see neurologists early in the course of their disease. The initial evaluation of first seizure patients may be inefficient due to the overuse of unnecessary tests such as CT scanning as well as the failure to optimize some tests that are performed such as MRI. Seizures are dramatic events in the life of an individual, and may cause considerable anxiety and socio-economic hardship. For many patients rapid access to a specialized epilepsy unit may lessen the anxiety associated with a potentially serious diagnosis. Early evaluation and testing may therefore improve patient satisfaction and allow more rapid optimization of treatment. In addition, the First Seizure Clinic is a unique resource for identifying patients early in the course of their illness who may be candidates for clinical trials of new diagnosis and treatment protocols.

Goals of the First Seizure Clinic

1. To provide rapid evaluation and treatment of pediatric first seizure patients, including all necessary diagnostic testing.
2. To be highly responsive to the needs of the pediatricians and family physicians.
3. To work in partnership with pediatricians and family physicians in the longitudinal management of newly diagnosed seizure patients.
4. To allow ascertainment of a cohort of patients at the onset of their seizure disorder to facilitate trials of early intervention strategies, including outcomes measures.
5. To promote cost efficient strategies for the clinical evaluation of first seizure patients using prospective data