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Evaluation and management of the first seizure in adults

Steven C Schachter, MD
Section Editor
Paul Garcia, MD
Deputy Editor
Janet L Wilterdink, MD


Seizures are a common occurrence, affecting an estimated 8 to 10 percent of the population over a lifetime [1,2]. Seizures account for 1 to 2 percent of all emergency department visits, and approximately one-quarter of these will be a first seizure [3].

The primary goal in evaluating a patient's first seizure is to identify whether the seizure resulted from a treatable systemic process or intrinsic dysfunction of the central nervous system and, if the latter, the nature of the underlying brain pathology. This evaluation will determine the likelihood that a patient will have additional seizures, assist in the decision whether to begin antiseizure drug therapy, and direct appropriate treatment to the underlying cause, if known.

The differential diagnosis and clinical features of seizures and the diagnostic evaluation of the first seizure in adults are reviewed here. Other paroxysmal events that can mimic seizure in adults, including syncope, migraine, transient ischemic attack, and psychogenic nonepileptic seizures, are reviewed separately. (See "Nonepileptic paroxysmal disorders in adolescents and adults" and "Syncope in adults: Clinical manifestations and diagnostic evaluation" and "Pathophysiology, clinical manifestations, and diagnosis of migraine in adults" and "Definition, etiology, and clinical manifestations of transient ischemic attack" and "Psychogenic nonepileptic seizures".)

The evaluation and management of convulsive and nonconvulsive status epilepticus, which are occasionally the first presentations of seizure, as well as the management of chronic epilepsy are reviewed separately. (See "Convulsive status epilepticus in adults: Classification, clinical features, and diagnosis" and "Nonconvulsive status epilepticus" and "Overview of the management of epilepsy in adults" and "Initial treatment of epilepsy in adults".)


A seizure is a sudden change in behavior caused by electrical hypersynchronization of neuronal networks in the cerebral cortex.

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Literature review current through: Nov 2017. | This topic last updated: Sep 08, 2017.
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