Neurol. praxi. 2010;11(6):386-390

The first epileptic seizure - diagnostic approach and indications to start the treatment

MUDr.Hana Krijtová, doc.MUDr.Petr Marusič, Ph.D.

Centrum pro epilepsie Motol, Neurologická klinika 2. LF UK a FN Motol, Praha

In acute period after the first seizure – loss of consciousness with convulsions with suspicion on GTCS – it is emphasized to distinguish

epileptic and nonepileptic origin (mostly convulsive syncope) and identify an acute disorder, which can cause provoked seizure. Later

on it is highly desirable to disclose appearance of inconspicuous seizures of other type, e.g. myoclonia, absences, focal seizures, in

patient history as it can prove diagnosis of epilepsy. CT scan is always recommended as soon as possible, MRI can be delayed. Except

for abnormal neurological findings, EEG abnormality – both nonspecific slowing and specific epileptiform changes – increases risk for

seizure recurrence. Initiation of antiepileptic therapy after first unprovoked seizure is reasonable when there is a high risk of recurrence

or complications of seizure.

Keywords: first seizure, provoked seizure, acute symptomatic seizure, epilepsy, diagnostic approach

Published: December 31, 2010  Show citation