A dedicated pediatric First Seizure Clinic (FSC) provided specialist evaluation in less than a week and enabled an epilepsy diagnosis at the initial visit for more than 1 in 5 children.

The findings come from an 8-year retrospective review of more than 1600 children referred to the FSC at Dayton Children’s Hospital (DCH) in Dayton, Ohio. The clinic integrates rapid EEG, targeted imaging, and multidisciplinary counseling at or before the initial appointment to streamline diagnosis and follow-up.

The review underscores how well the FSC model can streamline early evaluation and management, said study author Yash Agarwal, an undergraduate at Washington University in St. Louis who contributed to the project. He told Medscape Medical News that the findings demonstrate the clinic’s ability to shorten the path to specialist care and emphasized that similar models could be replicated in other communities where the need exists.

The findings were presented on December 6 at the American Epilepsy Society (AES) 79th Annual Meeting 2025.

Centralized Access

Before the clinic was established, wait times for a specialist evaluation often stretched beyond 53 days, Agarwal said. “This is not optimal for any family,” he noted, particularly when delayed diagnosis stalls treatment initiation.

The longer seizures go unaddressed, the greater the adverse impact on cognitive function, seizure outcomes, and overall health. “For children, even a 1-month delay in diagnosis and treatment can cause long-term developmental problems,” Gogi Kumar, MD, the study’s senior author and attending physician at DCH, said in a press release.

“Timely treatment can reduce the risk of injury and sudden unexpected death in epilepsy (SUDEP) and help children live healthier lives,” Kumar added.

The FSC at DCH functions as a centralized, “one-stop” access point designed to shorten the wait for a specialist evaluation while providing rapid access to MRI and ambulatory EEG. Although prior research has shown that adult FSCs are linked to lower subsequent hospital utilization, this is the first study to examine how a pediatric FSC affects access to care and early diagnosis following a first-time seizure.

The retrospective observational study included 1622 patients (median age, 7 years) seen at the DCH clinic from 2017 to 2025. Of these, 47.2% identified as female and 76.6% as White or Caucasian. About 46.9% had private insurance, and 51.8% had public insurance.

The children were referred to the clinic by community physicians, outside emergency departments (EDs), and the hospital’s ED. Reasons for referral included new-onset convulsive seizures, suspicion of focal seizures, seizure-like activity, or a recommendation by a provider for a seizure evaluation.

A Faster Pathway to Care

The clinic achieved a median lead time of 6 days from referral to specialist evaluation, with waits ranging from same-day visits to just over a month. Procedures were ordered for nearly two thirds of patients, most often long-term EEG monitoring and brain MRI. Initial visit diagnoses commonly included seizure-like events (21.6%), convulsions (15.8%), and, in about 1 in 5 children, epilepsy (20.9%).

“Being able to offer a diagnosis at the first visit for about 20% of patients is a huge deal,” Agarwal said. “Even if they don’t get a diagnosis on the first day because they may need another EEG or more imaging, we’re setting up a pathway for them, and that’s important.”

A timely diagnosis allows treatment to begin sooner, he added. “Outcomes are always better the earlier you see the patient and the earlier you start therapy.” Agarwal emphasized that the data suggest the model is advancing care in a meaningful way and improving the trajectory for children with new-onset seizures.

Agarwal said the team now plans to examine patient outcomes to better understand the clinic’s longer-term impact.

Commenting for Medscape Medical News, Kelly G. Knupp, MD, professor of pediatrics and neurology at the University of Colorado Anschutz Medical Campus in Aurora, Colorado, said the study is particularly important given the ongoing shortage of pediatric neurologists — a problem that “is probably going to get worse before it gets better.” This shortage means it “takes longer and longer” for families to secure an appointment with a specialist, she added.

Knupp said that having a dedicated program where children with possible seizures can be evaluated promptly is an important advance. She said she would also like to understand how families perceive the clinic because clinicians often view the experience through a medical lens, while parents may be overwhelmed by the volume of information delivered in a short period. 

She emphasized that receiving an epilepsy diagnosis can be life-altering for families and questioned whether parents are able to absorb everything presented during the visit or whether the process feels as though there’s too much information to absorb in a short period.