Emergency and Urgent Care - Suspected First Seizure

Introduction

You have been given this leaflet because you’ve had a suspected seizure (or fit), for which you’ve been referred to the first fit clinic where you will be seen by a specialist.

When you attend the clinic, it will be very helpful if someone who has witnessed you having a seizure can attend the appointment with you.

A further assessment will be done (which may include further investigations) and if epilepsy is suspected, treatment options will be discussed with you.

It is worth knowing though that many suspected first seizures are not true seizures or epilepsy.

You must not drive until you have been seen in clinic.

If you hold a driving licence, you MUST STOP driving immediately.

The Emergency Department clinician will document in your notes that you have been informed not to drive. This is not necessarily a permanent measure, but you must not drive until you are assessed by a specialist.

Unless another treatable cause for your seizures is found, you should tell the Driver and Vehicle Licensing Agency (DVLA).
Generally, you will be unable to drive for a minimum of six months.

Failure to inform the DVLA is a criminal offence. You may be fined up to £1,000 and your insurance invalidated if you do not inform them.

For more information:

https://www.gov.uk/epilepsy-and-driving

To contact the DVLA: www.gov.uk/contact-the-dvla

To telephone the DVLA: 0300 790 6806

Alternatively, you can pick up an information pack at the Post Office.

What do I tell my employer?

It is sensible to tell your line manager or occupational health department that you have had a suspected seizure, so you can discuss if any additional safety measures need to be taken.

You must inform you employer if your job involves driving (any vehicle), flying or you are in the armed forces, police, fire service, merchant navy, or if you or anyone else could be at risk if it happened again.

Examples include if your job involves working at heights, near water, with heat sources, machinery or with children or vulnerable adults.

Keeping safe and reducing potential risks

• Live a healthy lifestyle, limit alcohol intake to 1-2 units in 24 hours and avoid recreational drugs
• A shower is safer than a bath and do not bathe children
• Using a microwave is safer than a cooker
• Let people know where you are and when you expect to be back
• If you go swimming, tell the pool attendant you have previously had a suspected seizure
• Avoid activities where it would be difficult for help to get to you, for example scuba diving, skiing and lone activities
• Avoid unprotected heights and unsupervised areas of water
• Do not operate potentially dangerous machinery
• Avoid open flames and fires
• Avoid standing close to the edge of roads, tram or train platforms
• Do not ride a bike, particularly in heavy traffic

What if I have another seizure?

Information for family, friends and colleagues

You may wish to share this leaflet with your family, friends and colleagues to help them know what to do in the case of you having a further seizure.

If someone has a seizure

DO:

• Do stay calm, summon help
• Do check the time and monitor how long the seizure lasts
• Do loosen any tight clothing around their neck
• Do protect them from injury – remove sharp or hard objects from the area. If they are confused guide them away from danger
• If they have fallen place something soft under their head
• Once the seizure has finished, aid breathing by placing the person on their side and gently lift their chin, tilting their head backwards (the recovery position)
• If breathing remains laboured, check nothing is blocking the throat e.g. dentures 
• Once the above has been done and if safe to do so, it may be helpful to record the seizure on a phone as this may help the specialist in their assessment

DO NOT:

• Do not try to restrain the person or their movements
• Do not put anything between their teeth
• Do not try to move them unless they are in danger
• Do not give the person anything to eat or drink until they are fully recovered

Recovery Position

When should an ambulance be called?

Most seizures will stop on their own after a few minutes.

If someone witnesses you having a seizure, they will probably call 999 during the episode, but someone must call for an ambulance if a person:

• Has a convulsive shaking seizure, especially if not settling within a few minutes, or one convulsive seizure follows another without them regaining consciousness in between
• Injured themselves during a seizure or has difficulty breathing afterwards, or
• If they have concerns about the person’s condition

Similarly, call 111 or 999 if you are alone and think you have just had another seizure.

How do I describe what happened?

When you attend the first fit clinic it will be helpful if someone who has witnessed you having a seizure can attend the appointment with you, or if they cannot attend provide a record of the event.

Things to consider:

• What was the person doing before the episode started?
• Was there any mood change, e.g. excitement, anxiety, anger?
• Did they mention any unusual sensations or notice something happening?
• Did they become unconscious or were they confused?
• Did their colour change?
• Did their breathing alter and/or did they bite their tongue?
• Were there any movements in their body or limbs?
• Were they incontinent?
• How long did the episode last and how were they immediately afterwards?
• Keeping a record of dates and times that episodes occur is also helpful

Further Action

Epilepsy Action - https://www.epilepsy.org.uk/ - Freephone 0808 800 5050
NHS Choices - https://www.nhs.uk/conditions/Epilepsy/#
DVLA Guidance - www.gov.uk/epilepsy-and-driving
Salford Royal Appointment Enquiry Line - 0161 206 4100