Nurse led first seizure clinics-a dangerous experiment or an effective alternative to the norm?

In the United Kingdom (UK), people experiencing a suspected first seizure should be seen by a clinician with expertise in epilepsy within two weeks. First seizure clinics (FSC) aim to fast-track people outside the standard neurology outpatient system. Despite this, little over one in ten are seen within this timeframe. Most clinics are led by a consultant neurologist. There is a need to increase FSC provision utilising alternative expertise. A consultant nurse for the epilepsies led an innovative FSC, initially alongside a senior clinical fellow. Most patients were offered an electroencephalogram (EEG) (reported contemporaneously) at the FSC and there was provision for phlebotomy, electrocardiogram (ECG) and an urgent (same day) magnetic resonance imaging (MRI). In this prospective cohort study, we report 12-month clinical outcomes of our first 200 adult patients. 183/200 (91.5%) attended. 53 (26.5%) were seen within two weeks. 92% were given a diagnosis at FSC. 51 (25.5%) had epilepsy. 60 (30%) had an isolated seizure, 35% of which were provoked. 29 (14.5%) had functional dissociative seizures (FDS). 85/111 (76.5%) patients who had experienced at least one seizure were seizure-free at 12 months. Of 33 patients with FDS, 18 (55%) were seizure-free at 12 months. We present evidence that alternative methods of providing first seizure review can deliver timely, positive outcomes for patients. However, there must be robust governance arrangements in place involving a consultant neurologist. Many epilepsy specialist nurses will not have the experience, post registration qualifications, renumeration or willingness to undertake FSC. Therefore, there are limitations to the generalisability of these results.