Impact of an epilepsy nurse in reducing seizure mimic referrals

People referred to First Seizure Clinics (FSCs) often face long waiting times. Many have seizure mimics. This study aimed to evaluate the impact of an epilepsy nurse (EN) in reducing wait times and minimising seizure mimic referrals. We also aimed to illustrate the range of seizure mimics referred to the FSC and describe diagnostic revisions over time.

We prospectively collected data from 100 consecutive individuals seen in FSCs at our centre before and after the introduction of a new part-time EN. We followed up for a minimum of 12 months. Key outcomes included diagnostic revisions over time, changes in referral patterns, characteristics of seizure mimics, and time elapsed between referral and FSC appointment.

Patients (50 male, 50 female) had a median age of 41.4 years (range 18-90 years). Fifteen (15%) people had an abnormal MRI, and 33% had an abnormal EEG, including eleven (11%) with epileptiform abnormalities. Seizure mimics accounted for 29/50 (58%) diagnoses before the commencement of an epilepsy nurse and reduced to 19/50 (38%) after the commencement of an epilepsy nurse (p < 0.05). There was no significant reduction in clinic wait time post-EN (relative reduction in median wait time of 39%, p = 0.41). Common seizure mimics included syncope (18%) and Non-Epileptic Events (8%). Twelve people (8 pre-EN, 4 post-EN) had a diagnostic change to Epilepsy over the next 12 months after FSC.

An epilepsy nurse was associated with a reduction in the frequency of seizure mimics seen in our FSC. Further research is needed to investigate the impact of epilepsy nurses on the performance of FSCs.