I developed a service for children at Alder Hey for first fits. The lifetime incidence of a single unprovoked (afebrile) seizure is quite high with many occuring in youth and adolescence. Even two unprovoked seizures are relatively ok. There are many secondary (provoked) seizures which need to be identified though sometimes this is easier retrospectively. The epileptologists do have a limited interest in patients with one or two fits. There are a limited number series of patients followed up long enough to determine appropriate management. In the best series patients were identified after ct scanning. My patients were followed up in a dedicated clinic within 2 weeks of their presentation. There were a significant number who after reflection had not had fits. Those that were eventually diagnosed as epileptic had further fits quite soon after the initial seizure. After a second fit they were fast tracked via ct to neurology.
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