THE FIRST SEIZURE AND THE DIAGNOSIS OF EPILEPSY
A common story is for parents to be woken by the stertorous breathing or grunting of a child in the next bedroom. They go to him, thinking usually that he is having a bad dream, and find him staring, unresponsive, convulsing, and perhaps blue. Few if any parents can cope calmly with such a scene. It is usual for the family doctor to be telephoned at once, and, if there is any delay in his arrival, for an ambulance to be summoned as well. Many parents subsequently confess that they thought their child was dying, so they are acting in an entirely rational way. Almost invariably, however, by the time the family doctor or ambulance has arrived, the seizure is over, the child is sleeping peacefully, and the adults are making tea. But they will not sleep again that night. Many—though not all—are immediately aware of the nature of what they have just seen.
Although the first seizure can occur anywhere and at any time, another common scenario is for the first seizure to occur in a young woman in the company of her friends or at work. In this case, the lack of ready access to the family doctor, whose name and telephone number is unlikely to be known to the bystanders, results in an ambulance being almost invariably called, and the unfortunate young woman being rushed off to hospital. She will recover consciousness either in the ambulance or in the Accident and Emergency Department of the hospital. To the confusion invariably consequent to the generalized seizure must be added the feeling of ‘What on earth has happened to me, and how have I finished up here on a stretcher with strangers peering at me?’ Obviously, therefore, although ambulance services are rather prickly on this point, a friend should accompany her to hospital—not only to provide moral support when recovery of consciousness occurs but also to give an accurate account of events to the hospital staff. In this case, the diagnosis of a tonic-clonic seizure is clear, but in others matters are not so straightforward. It is important to distinguish between an epileptic seizure and some other event which may initially seem to be one. Patients may speak in terms of a ‘black-out’, ‘funny turn’, or ‘blank spell’, and we have to do our best to analyse the cause.
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