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.

Once thought to be a simple relay, the thalamus is now seen as a more dynamic player in overall cortical functioning. Several relatively recent observations created led to this new understanding: (1) Glutamatergic inputs can be classified as drivers (e.g., main conveyors of information) or modulators. Most inputs in the thalamus and cortex are modulators, and identifying the driver subset has provided insights into thalamocortical circuit functioning. (2) Much of the modulator input to the thalamus relates to control of the response mode of relay cells–tonic or burst. Which mode operates at any time affects the significance of the message conveyed to the cortex. (3) We now appreciate that most of thalamus, called higher order (e.g., pulvinar and medial dorsal nucleus), serves as a central relay in a transthalamic corticocortical information route organized in parallel with direct connections. First-order nuclei (e.g., lateral geniculate and ventral posterior nuclei) instead relay peripheral information to the cortex. Thus, the thalamus not only provides a behaviorally relevant, dynamic control over the nature of the information relayed, but it also plays a key role in basic corticocortical communication. These findings are reviewed, along with speculations regarding the functional significance of transthalamic pathways.

Seizures (epileptic) are manifestations of transient abnormal excessive or synchronized cerebral neuronal activity. Seizures may be provoked (acute conditions) or unprovoked (epilepsy). Seizures are classified as focal or generalized onset based on consistent clinical observation, EEG and imaging findings. Focal onset seizures originate from a single hemisphere while generalized seizures originate from bilateral hemispheres. Focal seizures may be further classified based on impairment of awareness (anytime during seizure) and motor or non-motor activity (at the very onset). Focal seizures without impaired awareness may not have surface EEG abnormalities. Focal seizures may secondarily generalize, these are now called focal to bilateral tonic clonic seizures. Generalized seizures are associated with impaired awareness, hence only motor or non-motor activity at onset is used to classify them. Common generalized motor seizures include generalized tonic clonic seizures (GTCs), tonic, atonic, myoclonic, myoclonic-atonic and epileptic spasms. Common generalized non-motor seizures include typical and atypical absences, myoclonic absences and absences with eyelid myoclonia.