Fits, faints and Funny turns GP Refresher week Dr Penny Mancais Paediatric Consultant Lead for Epilepsy

Learning objectives Who and when do I refer? What investigations might I do? How do I refer? What is my role as a GP Where can I go for further information.

Parental anxiety, pressure for a diagnosis, Epilepsy is a very emotive area,

May be epilepsy but more likely sncope or a non epileptic episode.

Who do I refer? Before, during, after, what happens after the event, neurological ,cardiac and behaviour/development examination adds very little to making a diagnosis ( consider BP and examine back of eyes)

What parts of the history would reassure me? Commonest differential is syncope Pallor, sweaty, feels hot, change of position, can twitch/stiffen but short lived with quick recovery. ?Epileptic: Sudden fall, often no warning, blank stare, headache, incontinence of urine, drowsy, longer

What investigations might I do as a GP? No need for any other tests

Who do I refer

How to refer in West Dorset Patch Consultant ( 4-6 week) On call Consultant ( babies, unwell, high level of concern) Rapid access Clinic ( normal with in 2 weeks) If have a diagnosis of Epilepsy already refer to Epilepsy Clinic. Some areas have specific first seizure clincs and may be seen first of al by a neurolgist.

On going role for GP Offer first Aid management, safety advice, diary

What happens at the hospital appt

Gps please don’t request 1:100 have abnormalities not signifcant Gps please don’t request 1:100 have abnormalities not signifcant. Does not exclude. Last national audit we do about 100 per year for first seizure

Where can I go for further information Epilepsy Action Young Epilepsy. Phone App. ILAE : good for professionals STARS. Blackout check list NICE and SIGN National audit of Epilepsy death and SUDEP DVLA

Any questions