Refer all patients after a first suspected seizure urgently, with an appointment within 2 weeks, to a clinician with expertise in assessing first seizures and diagnosing epilepsy for adults, and to a paediatrician for children and young people NICE CKS.
Carry out an individualised assessment of the risk of a second seizure, including checking for modifiable factors such as mental health problems, vascular risk factors, and sepsis NICE NG217.
Arrange neuroimaging, preferably an MRI scan within 6 weeks of referral, to identify structural causes, unless the patient has idiopathic generalised epilepsy or self-limited epilepsy with centrotemporal spikes NICE NG217.
Consider additional investigations such as a 12-lead ECG to identify cardiac conditions, and consider EEG testing—preferably within 72 hours of the seizure—to support diagnosis and determine seizure type NICE CKS,NICE NG217.
Discuss the benefits and risks of further investigations, including MRI, CT, EEG, and genetic testing, with the patient and their family or carers as appropriate NICE NG217.