People have the right to be involved in discussions and make informed decisions about their care, as described in NICE's information on making decisions about your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.
1.2 Specialist assessment and diagnosis
See also NICE's guideline on transient loss of consciousness ('blackouts') in over 16s for recommendations on initial assessment of people after a suspected transient loss of consciousness. In particular, see the recommendations on performing electrocardiogram (ECG) in the section on obtaining patient history, physical examination and tests and on features suggestive of epileptic seizures in the section on suspected epilepsy.
1.2.1
Take a detailed history from the child, young person or adult after a first suspected seizure, and from their families and carers if appropriate, and carry out a physical examination. If possible, use eyewitness accounts and video footage of the seizure to inform the assessment.
1.2.2
Evaluate people after a first suspected seizure with a 12-lead ECG to help identify cardiac-related conditions that could mimic an epileptic seizure.
1.2.3
Be aware that metabolic disturbance, including hypoglycaemia, can result in seizures.
1.2.4
Offer brain neuroimaging tests if an underlying structural cause is suspected (see also the section on neuroimaging).
Electroencephalogram (EEG)
1.2.5
If the person's history and examination suggests an epileptic seizure, and a diagnosis of epilepsy is suspected, consider a routine EEG carried out while awake to support diagnosis and provide information about seizure type or epilepsy syndrome.
1.2.6
Do not use EEG to exclude a diagnosis of epilepsy.
1.2.7
If an EEG is requested after a first seizure, perform it as soon as possible (ideally within 72 hours after the seizure).
1.2.8
When offering an EEG, discuss the benefits and risks of provoking manoeuvres during EEG, such as hyperventilation and photic stimulation, with the person and their family or carers if appropriate. If agreed, include provoking manoeuvres during routine EEG to assess a suspected first seizure.
1.2.9
If routine EEG is normal, consider a sleep-deprived EEG if agreed with the person, and their family or carers if appropriate, after discussing the benefits and risks.
1.2.10
If routine and sleep-deprived EEG results are normal and diagnostic uncertainty persists, consider ambulatory EEG (for up to 48 hours).
1.5 Antibody testing
1.5.1
Consider antibody testing in discussion with a neurologist for people with new-onset epilepsy if autoimmune encephalitis is suspected.