Acute Medicine | Neurology | First fit: Investigation and management

First Fit: Investigation and Management
Session Overview
Description
This session reviews adult first fit presentations, including the characteristic features of different epileptic seizures, when to admit to hospital, anti-epileptic therapy and important information to give patients.

Learning Objectives
By the end of this session you will be able to:

• State the common types of seizures and seizure mimics
• Specify a management strategy for patients presenting with a first fit
• Summarise the Driver and Vehicle Licensing Agency (DVLA) regulations for a patient presenting with a first fit

An epileptic seizure is a transient occurrence of signs and/or symptoms due to an abnormal synchronised discharge of cerebral neurons.

Epilepsy is defined as a syndrome characterised by an enduring tendency to have unprovoked (epileptic) seizures.

The definition of epilepsy requires the occurrence of at least one epileptic seizure and evidence of an enduring alteration in the brain that increases the likelihood of future seizures such as:

• An ‘epileptiform’ EEG abnormality 
• An appropriate lesion on structural brain imaging (CT or MRI)
  or
• The presence of recurrent (two or more) seizures