Article Text

Management of the first seizure: an evidence based approach
  1. U Seneviratne
  1. Department of Neuroscience, Monash Medical Centre, Melbourne, Australia & Alfred Hospital, Melbourne, Australia
  1. Correspondence to Dr U Seneviratne, Department of Neuroscience, Monash Medical Centre, Clayton Road, Clayton VIC 3168, Australia; u.seneviratne{at}; wusenevi{at}


The first seizure is more common than epilepsy. A detailed history is vital in the assessment in order to reveal unreported minor seizures such as myoclonic jerks, simple partial seizures and absences in the past. The first seizure could be provoked or unprovoked. Provoked seizures have a lower risk or recurrence. Electroencephalogram (EEG) studies and neuroimaging are essential components in the diagnostic work up. Abnormal neurological status and abnormal EEG are the most significant predictors of seizure recurrence. Antiepileptic drug (AED) treatment after the first seizure significantly reduces seizure recurrence rate in the first 2 years. However it does not appear to change the long term outlook. There are some patients who would benefit from AED treatment after the first seizure. This paper discusses the current evidence on this multifaceted clinical problem which would help formulate a rational management plan.

  • epilepsy
  • seizure
  • electroencephalography
  • recurrence

Statistics from


  • Competing interests None.

  • Provenance and Peer review Not commissioned; externally peer reviewed.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.