What are the guidelines for referring a patient for further investigation after a first seizure?

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 ¹.

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 ².

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 ².

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 ¹,².

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 ².