First seizures, the epilepsies and other paroxysmal disorders prospective audit of a first seizure clinic.

BACKGROUND: Despite high life time prevalence of first seizures there is a dearth of information relating to uptake and efficient use of resources for first seizure services. AIMS: To determine referral pattern, epilepsy and non-epilepsy diagnoses, investigations performed, follow-up appointments generated and resource utilisation at a first seizure clinic. METHODS: A prospective study of 200 consecutive attendees was performed over a 16 month period at a first seizure clinic in the Institute of Neurological Sciences, Glasgow. RESULTS: 139 (69.5%) patients were general practitioner and 61 (30.5%) hospital referrals. Fifty-six (28%) patients were newly diagnosed with epilepsy and 26(13%) with an unprovoked first seizure. Alcohol and/or drug abuse were contributing factors in 23 patients or 19.5% of all seizure cases. Twenty-one (35%) of 62 EEGs contained epileptiform activity which assisted with an epilepsy diagnosis. Overall 22 (29%) of 77 CT head scans disclosed abnormalities and 20 (36%) of 56 in those with an index event of seizure. Brain tumours were identified in four patients or 5% of all patients who underwent CT scanning. All patients with an epilepsy diagnosis were offered follow up with a consultant neurologist and epilepsy nurse specialist. Late cancellation and non-attendence rates were 35-40% for initial clinic appointments and 16% for first seizure clinic review appointments. CONCLUSION: With provision of fast track, easy access first seizure services, individuals may be more likely to both attend and present earlier with fewer seizure events at first contact.

Infant growth and aorta total lipid fatty acids.

Abnormal fetal and infant growth have increasingly been correlated with adult onset cardiovascular disease. To date, there is little known about the lipid fatty acid profiles in infant cardiovascular tissue. Therefore, we analysed total lipid fatty acids from thoracic and abdominal aorta intima and media from 24 normally grown sudden infant death syndrome cases. Aorta from small for gestational age (n = 2), failure to thrive from birth (n = 3), and premature (n = 1) infants were also examined. Dihomo-gamma-linolenic acid (C20:3n-6) and oleic acid (C18:1n-9) concentrations were significantly lower in the thoracic than in the abdominal aorta. Similar dietary related differences were found in the subgroup (n = 15) of infants fed on formula milks. Both abdominal and thoracic intimal arachidonic (C20:4n-6) to dihomo-gamma-linolenic acid ratios were greater in the infants with retarded growth after birth than in their normally grown counterparts. Growth restriction in infancy might disrupt the normal accretion of vascular endothelial polyunsaturated fatty acids.