Abstracts

Rationale: First Seizure Clinics (FSCs) are designed to provide patients with expedited access to specialist evaluation following a first-time seizure. FSCs provide shorter lead times (time from referral to appointment) and quicker diagnoses, bypassing outpatient neurology wait times. Early access facilitates diagnostic clarity and improves long-term outcomes. FSC attendance in adults is associated with reduced rates of subsequent hospital utilization.¹ A delay in diagnosis of >1 month in early onset epilepsy can lead to substantial decrements in development and IQ later in childhood.² Data on the efficacy of FSC in children is lacking. The aim of the study is to describe the structure, patient population, access time, and assess effectiveness.

Methods: The FSC at Dayton Children’s Hospital (DCH) was established in 2017. Referral sources included community physicians, outside emergency departments (EDs), and the DCH ED. Referral reasons included new-onset convulsive seizures, suspicion of focal seizures, seizure-like activity, or provider-recommended seizure evaluation. During or prior to the initial visit, a sleep-deprived EEG was obtained, and patients received a social work consultation, seizure education, and an action plan based on diagnosis. A retrospective observational cohort study was conducted between January 1, 2017, and April 30, 2025. Patients with known symptomatic seizures or epilepsy were excluded. Data collected included demographics, insurance type, lead time in days, procedures ordered, and FSC visit diagnoses.

Results: 1622 patients were included with a median age of 7.0 years at time of visit. Of these, 47.2% identified as female, and 52.8% as male. Most patients identified as White or Caucasian (76.6%), followed by Black or African American (14.8%). 46.9% patients had private insurance and 51.8% had public insurance. The median lead time for FSC was 6.0 days (range: 0–33 days). A total of 1021 patients (62.9%) had procedures ordered; of these the most common were long term EEG monitoring (77.2%) and Brain MRI (44.5%). Primary diagnoses at the initial visit included seizure-like activity (21.6%), convulsions (15.8%), and epilepsy (20.9%). (Table 1)

Conclusions: The FSC at DCH offers timely access for children presenting with seizure-like symptoms, with a median lead time under a week. A definitive epilepsy diagnosis was made at the first visit in 20.9% of patients. Distributions of race and insurance seen in the FSC mirrored those of the broader local outpatient pediatric population, indicating equitable access. These findings support the FSC model as an effective approach for early identification and management of pediatric epilepsy. 



Funding: No funding was recieved for this study.