How accurate are witnesses of first suspected seizures in recalling semiology at clinically relevant timepoints? - A UK experimental study with a pilot intervention

Sep 30, 2026

Uploaded by Mimi

Objective: A first-seizure clinic challenge is determining whether a reported event was epileptic, yet witness accounts are often collected weeks after the event. Guidelines recommend review within 2 weeks, but median wait times can be around 7 weeks in the UK. This study quantified witness recall accuracy at these intervals and tested whether systematic questioning soon after viewing improves later recall versus free recall. Methods: Adults viewed a seizure video and were randomized to four conditions.

LanguageEnglish

CategoryHealthcare

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Pages14

Reading Time35 min

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Abstract

Objective

Methods

Results

Introduction

DOI: 10.1111/epi.18624 RESEAR CH ARTICLE How accurate are witnesses of first suspected seizures in recalling semiology at clinically relevant timepoints? A UK experimental study with a pilot intervention Adam J. Noble1 | Steven Lane2 | Paul New3 | Harriet Cope3 | Chloe Foley3 | Holly Lynn Williams3 | Laszlo Sztriha4 | Graham Powell5 | Markus Reuber6 | Anthony G. Marson7 1Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK 2Department of Health Data Science, University of Liverpool, Liverpool, UK 3Department of Psychological Sciences, University of Liverpool, Liverpool, UK 4Department of Neurology, King's College Hospital National Health Service Foundation Trust, London, UK 5Neurology Department, Walton Centre National Health Service Foundation Trust, Liverpool, UK 6Department of Neuroscience, School of Medicine and Population Health, University of Sheffield, Sheffield, UK 7Department of Pharmacology and Therapeutics, University of Liverpool, UK Correspondence Adam J. Noble, Department of Public Health, Policy and Systems, Institute of Population Health Sciences, The Whelan Building, Ground Floor, University of Liverpool, L69 3GL, UK. [Email:](Email: adam.noble@liv.ac.uk)[ adam.noble@liv.ac.uk](Email: adam.noble@liv.ac.uk) Abstract Objective: A key diagnostic challenge at “first seizure” clinic appointments is determining whether the reported event was epileptic. Witness accounts are often critical, yet such appointments typically occur weeks after the event. Guidelines recommend review within 2 weeks. Wait times are however often longer, with a median of 7 weeks in countries such as the UK. The accuracy of witness recall at these clinically relevant intervals and whether their confidence predicts accuracy have never been determined. This study addressed these fundamental questions. It also piloted a potential intervention: whether asking witnesses a set of systematic questions immediately after viewing a suspected seizure improves recall at follow-up, compared to the usual free recall approach used by first responders. Methods: In this UK-based experimental study, adults (≥18years old) viewed a video of an epileptic seizure and were randomized into four conditions: A (immediate free recall + 2-week follow-up), B (immediate free recall + 7-week followup), C (immediate systematic questions + 2-week follow-up), and D (immediate systematic questions + 7-week follow-up). The primary outcome was accuracy on 15 standardized questions addressing key semiological features, scored against consensus ratings from five neurologists. Results: Of a representative sample of 304 participants, 295 (97%) fully viewed the video, and 94.7% completed follow-up. At 2 weeks, participants answered 54.4% of questions correctly—only 3.9%(95% confidence interval [CI] = .52–7.3) more than those at 7 weeks. Confidence was poorly correlated with accuracy. Immediate systematic questioning improved later recall by 6.7%(95% CI = 3.3– 10.0) . A definitive trial of this intervention would require 926 participants. Significance: This is the first evidence on the accuracy of witness recall at clinically relevant intervals. Recall is modest even within recommended timeframes and declines only slightly by 7 weeks. Witness confidence does not predict This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2025 The Author(s). Epilepsia published by Wiley Periodicals LLC on behalf of International League Against Epilepsy. accuracy. Immediate structured questioning may enhance later recall and thus support seizure diagnoses. KEYWORDS accurate diagnosis, first seizures, recall, waiting times, witnesses 1 | INTRODUCTION Seizures and seizure-like events are common with 1 in 25 people experiencing at least one epileptic seizure by age 85 years.1 Guideli

FAQs

What diagnostic problem does the study address at first-seizure clinic appointments?

It addresses how to determine whether the reported event was epileptic when witness accounts are collected weeks after the event rather than promptly.

How were participants randomized in the experimental study?

Adults viewed a seizure video and were randomized into four conditions combining immediate free recall or immediate systematic questions with follow-up at 2 weeks or 7 weeks.

What were the key findings about witness recall over time?

Recall was modest at 2 weeks and declined only slightly by 7 weeks; witness confidence showed poor correlation with accuracy.

Sep 30, 2026

Uploaded by Mimi