Abstract
First seizures are often perceived as devastating events by patients and their families
due to the fear of having a life-long disease. One in 10 people experiences one or
more seizures during their lifetime, while 1 in 26 people develops epilepsy. Acute
symptomatic seizures are often related to a provoking factor or an acute brain insult
and typically do not recur. Careful history and clinical examination should guide
clinicians' management plans. Electroencephalography and brain imaging, preferably
with epilepsy-specific magnetic resonance imaging, may help characterize both etiology
and risk of seizure recurrence. Antiepileptic drugs should be initiated in patients
with newly diagnosed epilepsy. In patients without an epilepsy diagnosis, the decision
to prescribe drugs depends on individual risk factors for seizure recurrence and possible
complications from seizures, which should be discussed with the patient. Counseling
about driving and lifestyle modifications should be provided early, often at the first
seizure encounter.
Keywords
first seizure evaluation - antiepileptic drug - electroencephalography - epilepsy
