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First Seizure or Fit

A first fit always needs to be seen in person

NICE says everyone who has a first seizure should see a specialist within two weeks. The free check tells you what to do now, and what a proper assessment has to include.
  • Free · no card needed
  • Built from NICE CG137
  • Includes DVLA driving rules
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First Seizure or Fit

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First Seizure or Fit
Introduction

What first seizure or fit can mean

A first fit is frightening, and it is often the people around you who saw what happened rather than you. What they noticed matters as much as what you remember.

There is no “all clear” result for a first seizure on this platform. NICE is unambiguous: every suspected first seizure needs a specialist opinion. So the lowest outcome the check can give you is amber, meaning book a specialist appointment. It will never tell you to sit tight and do nothing.

Call 999 now if any of these are happening
These are emergencies. Treatment has to start within minutes.
  • A seizure that has lasted longer than five minutes 
  • One seizure after another, without the person waking up properly in between 
  • A seizure in someone who is pregnant — this is treated as eclampsia until proven otherwise 
  • The person is not breathing normally, or their lips are blue 
  • The seizure happened in water, or they were badly injured 
  • It is their first ever seizure and they have not come round 
  • While you wait: move anything hard away from them, put something soft under their head, and turn them on their side once the shaking stops. Never put anything in their mouth. If they have been prescribed buccal midazolam, give it now.
Source: NICE CG137 / NG217 (status epilepticus) · NICE NG133 (seizure in pregnancy — eclampsia)
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Do it now. Every minute makes a difference.

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Why a first fit cannot be assessed over video

Four parts of a first-seizure assessment simply cannot be done down a camera. This is why the check always routes a first seizure to a face-to-face appointment.

  1. A physical examination. Weakness on one side after a fit — called Todd’s paresis — can only be found by examining you. So can changes in your reflexes, balance and walking.
  2. A heart tracing (12-lead ECG). Some blackouts that look exactly like a fit are actually caused by the heart. Missing that is dangerous, because the treatment is completely different.
  3. A prolactin blood test. Taken within ten to twenty minutes of a convulsive seizure, it can help tell an epileptic seizure from a faint or a non-epileptic event. The window is short.
  4. A DVLA letter. UK law requires a letter from a consultant who has assessed you in person. A video call will not do. 

Source: NICE CG137 — specialist assessment within two weeks; NICE NG217

first-seizure

You must stop driving today

This applies from the moment the seizure happened, not from when you get a diagnosis.

Cars and motorbikes (Group 1): you must normally be free of seizures for six months before you can drive again.

Lorries and buses (Group 2): the period is five years.

Telling the DVLA is your legal responsibility, and it is a criminal offence not to. We cannot do it for you. Your consultant will give you a letter setting out their assessment, and your seizure package includes it, but you must make the declaration yourself.

Check your own situation on GOV.UK, because the rules differ depending on the type of seizure and whether it happened while you were asleep.

Source: DVLA Assessing fitness to drive (GOV.UK)

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What the person who saw it should write down

Bring this to your appointment. It changes the diagnosis more often than any scan.

What you were doing in the minutes beforehand

Whether you went stiff first, and which way your head or eyes turned

How long the shaking lasted, timed if possible

Whether you bit your tongue, and if so which part

Whether you wet yourself

How long it took you to come round, and whether you were confused afterwards

Whether you had been drinking, missed sleep, or missed a dose of any medicine

Source: NICE CG137 — eyewitness account central to seizure diagnosis

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Some medicines make seizures more likely

A number of common medicines lower the level at which the brain will fit. Bupropion, used for stopping smoking and for depression, is one of the clearest examples. Tramadol, some antidepressants and some antibiotics can do the same, particularly at higher doses or if you stop them suddenly.

Alcohol matters too. Seizures are more common while withdrawing from heavy drinking than while drinking.

The check reviews what you are taking and passes anything relevant to the neurologist.

Do not stop any prescribed medicine because of what this page says. Speak to your prescriber first.

Source: BNF · NICE CG137

Symptoms we ask about

We ask about mood, memory, motor skills, and sensory changes to tailor your diagnosis and treatment.

common

Going stiff, then shaking 

How long the episode lasted 

Confusion or sleepiness afterwards 

Tongue biting or wetting yourself 

Whether you drive, and what licence you hold 

Whether you are or could be pregnant

What happens next

Every first-seizure result is routed to a face-to-face appointment with a consultant neurologist. Packages start at £525 and include the physical examination, the ECG, the blood tests and the DVLA letter.
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