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Practice corner: will it happen again doctor? Prognosis after a first seizure

Susan attends with her mother for a consultation at the end of Monday morning surgery. On the previous Friday evening, 22 year old Susan was alone in the kitchen when her mother heard a clatter of kitchen utensils. She went through to find Susan unconscious on the floor in a pool of urine with her arms and legs shaking. This subsided after a couple of minutes leaving Susan drowsy and confused. Susan takes no regular medication and has had no serious illnesses in the past. There is no suspicion that alcohol or illicit drugs are involved. This is the first time that something like this has ever happened. She was seen in the local accident and emergency department and allowed home after being reassured that her blood tests, heart tracing, and clinical examination were all entirely normal. A neurological outpatient appointment is being organised, and Susan has been told that she mustn’t drive.

Both Susan and her mother are very worried that she’s going to have another convulsion. We discuss some of the implications of her recent convulsion and the difficulty of adopting an essentially “wait and see” approach pending further neurological assessment. I’m reluctant to hazard a guess as to the likelihood of a recurrence. My clinical intuition is that the risk of recurrence is quite high (if pushed I’d estimate 70% over 12 months). A straw poll of 6 general practitioner (GP) colleagues over morning coffee produced a wider range of estimates (10, 20, 40, 60, and 70%). But I’m …