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1 - How Do I Evaluate a First-Time Seizure?

Published online by Cambridge University Press:  28 January 2023

Patrick Landazuri ,
Nuria Lacuey Lecumberri ,
Laura Vilella Bertran ,
Mark Farrenburg  and
Samden Lhatoo
Patrick Landazuri
Affiliation:
University of Kansas Medical Centre
Nuria Lacuey Lecumberri
Affiliation:
University of Texas Health Science Center, Houston
Laura Vilella Bertran
Affiliation:
University of Texas Health Science Center, Houston
Mark Farrenburg
Affiliation:
University of Kansas Medical Centre
Samden Lhatoo
Affiliation:
University of Texas Health Science Center, Houston
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Summary

First-time seizures are a common part of neurology practice. Making an accurate and specific diagnosis is achievable by taking an excellent history. Clinicians should keep in mind that seizures are only part of the differential in a patient with a first-time event, with other diagnoses like syncope common as well. This history should focus on what the seizure feels like to the patient and looks like to observers. Two classification systems, the seizure semiology and International League Against Epilepsy (ILAE), exist to make communicating complex information easier. Key semiology history includes the presence or absence of auras, altered awareness, or convulsions. In addition to history, laboratory, EEG, and imaging data can inform to the specific patient diagnosis. If you determine that the patient has had a first-time seizure without a clear epilepsy diagnosis, you can tell them seizure that the recurrence risk is 40%. If you determine the patient has epilepsy, you can tell them that 50% of people are seizure-free with the first medication used. Patients should be reassured that they can live normal lives with most jobs being obtainable and family life being a possibility if the patient so chooses.

Keywords

seizuresemiologyauraconvulsiongeneralizedfocaltonicclonicabsencecomplex partial
Type
Chapter
Information
Seizure and Epilepsy Care
The Pocket Epileptologist
 , pp. 1 - 22
Publisher: Cambridge University Press
Print publication year: 2023

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References

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