Skip to main content
SpringerLink
Log in

Managing an Unprovoked First Seizure in Adults

  • Commentary
  • Published:
CNS Drugs Aims and scope Submit manuscript

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Hauser WA, Beghi E. First seizure definitions and world-wide incidence and mortality. Epilepsia. 2008;49(Suppl 1):8–12.

    Article  PubMed  Google Scholar 

  2. Institute of Medicine. Epilepsy across the spectrum: promoting health and understanding. Washington, DC: The National Academies Press; 2012. p. 292–306.

  3. Commission on Epidemiology and Prognosis, International League Against Epilepsy. Guidelines for epidemiologic studies on epilepsy. Epilepsia. 1993;34:592–6.

    Article  Google Scholar 

  4. Krumholz A, Wiebe S, Gronseth G, et al. Practice parameter: evaluating an apparent unprovoked first seizure in adults (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2007;69:1996–2007.

    Article  CAS  PubMed  Google Scholar 

  5. Krumholz A, Wiebe S, Gronseth G, et al. Evidence-based guideline: management of an unprovoked first seizure in adults. Report of the Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2015;84:1705–13.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Hirtz D, Ashwal S, Berg A, et al. Practice parameter: evaluating a first nonfebrile seizure in children. Report of the Quality Standards Subcommittee of the American Academy of Neurology, the Child Neurology Society, and the American Epilepsy Society. Neurology. 2000;55:616–23.

    Article  CAS  PubMed  Google Scholar 

  7. American College of Emergency Physicians Clinical Policies Subcommittee on Seizures. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with seizures. Ann Emerg Med. 2014;63:437–47.

  8. King MA, Newton MR, Jackson GD, et al. Epileptology of first seizure presentation: a clinical, electroencephalographic and magnetic resonance imaging study of 300 consecutive patients. Lancet. 1998;352:1007–11.

    Article  CAS  PubMed  Google Scholar 

  9. Fountain NB, Van Ness PC, Swain-Eng R, et al. Quality improvement in neurology: AAN epilepsy quality measures. Report of the Quality Measurement and Reporting Subcommittee of the American Academy of Neurology. Neurology. 2011;76:94–9.

    Article  CAS  PubMed  Google Scholar 

  10. Fountain NB, Van Ness PC, Bennett A, et al. Quality improvement in neurology: epilepsy update. Quality measure set. Neurology. 2015;84:1483–7.

    Article  PubMed  Google Scholar 

  11. Firkin A, Marco DJT, Saya S, et al. Mind the gap: multiple events and lengthy delays before presentation with a “first seizure”. Epilepsia. 2015;56:1534–42.

    Article  PubMed  Google Scholar 

  12. Hauser WA, Rich SS, Lee JR-J, et al. The risk of recurrent seizures after two unprovoked seizures. New Engl J Med. 1988;338(7):429–34.

    Article  Google Scholar 

  13. Jacoby A, Gamble C, Doughty J, et al. Quality of life outcomes of immediate or delayed treatment of early epilepsy and single seizures. Neurology. 2007;68:1188–96.

    Article  CAS  PubMed  Google Scholar 

  14. Fisher RS, Acevedo C, Arzimanoglou A, et al. A practical clinical definition of epilepsy. Epilepsia. 2014;55(4):475–82.

    Article  PubMed  Google Scholar 

  15. First Seizure Trial Group. Randomized clinical trial on the efficacy of antiepileptic drugs in reducing the risk of relapse after a first unprovoked tonic-clonic seizure. Neurology. 1993;43:478–83.

    Article  Google Scholar 

  16. Marson A, Jacoby A, Johnson A, et al. Immediate versus deferred antiepileptic drug treatment for early epilepsy and single seizures: a randomized controlled trial. Lancet. 2005;365:2007–13.

    Article  CAS  PubMed  Google Scholar 

  17. Chandra B. First seizure in adults: to treat or not to treat. Clin Neurol Neurosurg. 1992;94(Suppl):S61–3.

    Article  PubMed  Google Scholar 

  18. Gilad R, Lampl Y, Gabbay U, et al. Early treatment of a single generalized tonic-clonic seizure to prevent recurrence. Arch Neurol. 1996;53:1149–52.

    Article  CAS  PubMed  Google Scholar 

  19. Ruggles KH, Haessly SM, Berg RL. Prospective study of seizures in the elderly in the Marshfield Epidemiologic Study Area (MESA). Epilepsia. 2001;42:1594–9.

    Article  CAS  PubMed  Google Scholar 

  20. French JA, Kanner AM, Bautista J, et al. Efficacy and tolerability of the new antiepileptic drugs I: treatment of new onset epilepsy. Report of the Therapeutics and Technology Assessment Subcommittee and Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2004;62:1252–60.

    Article  CAS  PubMed  Google Scholar 

  21. Ramsay E, Faught E, Krumholz A, For the CAPSS-272 Study Group, et al. Efficacy, tolerability, and safety of rapid initiation of topiramate versus phenytoin in patients with new-onset epilepsy: a randomized double-blind clinical trial. Epilepsia. 2010;51:1970–77.

  22. Perruca P, Jacoby A, Marson AG, et al. Adverse antiepileptic drug effects in new-onset seizures: a case control study. Neurology. 2011;76:273–9.

    Article  Google Scholar 

  23. Bonnett LJ, Shukralla A, Tudur-Smith C, et al. Seizure recurrence after antiepileptic drug withdrawal and the implications for driving: further results from the MRD Antiepileptic Drug Withdrawal Study and a systematic review. J Neurol Neurosurg Psychiatry. 2011;82(1328–1333):24.

    Google Scholar 

  24. Scottish Intercollegiate Guidelines Network (SIGN). Diagnosis and management of epilepsy in adults. Edinburgh: SIGN; 2015: SIGN publication no. 143. [May 2015]. Available from: http://www.sign.ac.uk. Accessed 11 Feb 2016.

Download references

Author information

Authors and Affiliations

  1. Neurology, Charleston Area Medical Center, Charleston, WV, USA

    David S. Gloss

  2. Room S12C09, Universtiy of Maryland Medical Center, 22 South Greene Street, Balimore, MD, 21201, USA

    Allan Krumholz

Authors
  1. David S. Gloss
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Allan Krumholz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Allan Krumholz.

Ethics declarations

Funding

Dr. Gloss is a paid evidence-based medicine consultant for the American Academy of Neurology, and Level of Evidence Associate Editor for Neurology. Dr. Krumholz serves on the editorial board for Clinical EEG and Neuroscience, and has received royalties from UpToDate.

Conflict of interest

Dr. Gloss was a member of the two American Academy of Guidelines Development Committees on unprovoked first seizures in adults that are discussed in this commentary. Dr. Krumholz was the chair and a member of the two American Academy of Guidelines Development Committees on unprovoked first seizures in adults that are discussed in this commentary.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gloss, D.S., Krumholz, A. Managing an Unprovoked First Seizure in Adults. CNS Drugs 30, 179–183 (2016). https://doi.org/10.1007/s40263-016-0321-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40263-016-0321-z

Keywords

Search

Navigation