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Management of a First Seizure

Bergey, Gregory K. MD, FAAN

CONTINUUM: Lifelong Learning in Neurology: February 2016 - Volume 22 - Issue 1, Epilepsy - p 38–50
doi: 10.1212/CON.0000000000000271
Review Articles

ABSTRACT Purpose of Review: Assessment of the patient with a first seizure is a common and important neurologic issue. Less than 50% of patients who have a first unprovoked seizure have a second seizure; thus, the evaluation should focus on determining the patient’s risk of seizure recurrence.

Recent Findings: A number of population studies, including some classic reports, have identified the relative risk factors for subsequent seizure recurrence. The 2014 update of the International League Against Epilepsy definition of epilepsy incorporates these findings, and in 2015, the American Academy of Neurology published a guideline that analyzed the available data.

Summary: Provoked or acute symptomatic seizures do not confer increased risk for subsequent unprovoked seizure recurrence. Multiple seizures in a given 24-hour period do not increase the risk of seizure recurrence. Remote symptomatic seizures, an epileptiform EEG, a significant brain imaging abnormality, and nocturnal seizures are risk factors for seizure recurrence. Antiepileptic drug therapy delays the time to second seizure but may not influence long-term remission.

Address correspondence to Dr Gregory K. Bergey, Johns Hopkins School of Medicine, 600 North Wolfe Street, Meyer 2-147, Department of Neurology, Baltimore, MD 21287, gbergey@jhmi.edu.

Relationship Disclosure: Dr Bergey has received personal compensation for serving as an associate editor of Neurotherapeutics and has received research support from the National Institutes of Health.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Bergey reports no disclosure.

© 2016 American Academy of Neurology
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