First Time Seizure

The approach to a first time seizure is to first obtain a thorough description of the episode. This will help you differentiate a nonepileptic seizure from an epileptic one. Then, assess for possible triggers for the episode and whether the patient has had any unrecognized seizures in the past. After a first time seizure, an EEG and MRI seizure protocol should be performed to assess the patient’s risk for a recurrent seizure. If these are normal, the chance for a second seizure is ~30% and AEDs are typically not recommended.