Synopsis
Recognise and document seizures accurately in people with learning disability, prevent avoidable physical and treatment harm, discuss individual mortality risk accessibly, and coordinate at least annual epilepsy and medication review with specialist input when needed.
- Use eyewitness description and video where available to classify suspected seizures; establish onset, awareness, movement, colour, breathing, duration, recovery, injuries and possible triggers.
- Learning disability does not make every unusual movement epileptic, and it must not block ordinary EEG, imaging, genetic, tertiary or surgical assessment when clinically indicated.
- Create an accessible seizure and emergency plan stating usual events, timing threshold, first aid, rescue medicine, escalation, postictal care and who may administer treatment.
- NICE advises at least annual monitoring review for adults with epilepsy and learning disability, with more frequent review for ongoing seizures, high SUDEP risk, serious comorbidity or complex medicines.
- Review every antiseizure and psychotropic medicine for indication, seizure effect, interactions, adverse effects, adherence, formulation, swallowing, administration records and person-centred goals.
- Discuss epilepsy-related death and SUDEP from diagnosis in an accessible, individualised way, including the importance of seizure control, adherence and relevant night-time risk.
- Do not stop antiseizure medicine abruptly; withdrawal after sustained seizure freedom requires individual specialist assessment, a gradual plan and discussion of recurrence and SUDEP risk.
Key red flags
A first suspected seizure or recurrence after remission requires urgent specialist assessment; collapse may instead be syncope, arrhythmia, hypoglycaemia, dissociation or another cause.
Prolonged convulsion, incomplete recovery, cyanosis, major injury, focal deficit, fever, pregnancy or a substantially changed seizure pattern needs emergency evaluation.
Uncontrolled bilateral tonic-clonic seizures, missed antiseizure medicine, alcohol or drug misuse and sleeping or living alone increase epilepsy-related death risk and require an individual prevention discussion.
New sedation, ataxia, tremor, falls, dysphagia, weight change, mood disturbance, rash, bruising or cognitive decline may indicate antiseizure medicine harm or interaction.
Valproate or topiramate exposure without current reproductive-risk review, accessible counselling and required safeguards is a prescribing-safety concern, not a routine repeat issue.
Investigation priorities
Characterise onset, semiology, duration and recovery and distinguish likely seizure from a mimic.
Management branches
A first, recurrent or changed paroxysmal event may represent an epileptic seizure.
- Obtain the person's and eyewitness accounts, safe video if available, event timing, recovery, injuries, medicines, acute illness, substances and prior baseline.
- Assess physical and neurological findings, glucose and ECG or other urgent causes according to the presentation, treating status or injury immediately.
- Refer urgently for specialist assessment after a first suspected seizure or recurrence after remission and make interim first-aid and safety advice accessible.