Skip to main content Accessibility help
×
Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-24T03:43:41.633Z Has data issue: false hasContentIssue false

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

Published online by Cambridge University Press:  28 January 2023

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
Get access

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.

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Works Cited

King, MA, Newton, MR, Jackson, GD et al. Epileptology of the first-seizure presentation: A clinical, electroencephalographic, and magnetic resonance imaging study of 300 consecutive patients. Lancet. 1998;352(9133):1007–11.CrossRefGoogle ScholarPubMed
Rosenow, F and Lüders, H. Presurgical evaluation of epilepsy. Brain. 2001;124(Pt. 9):1683–700.CrossRefGoogle ScholarPubMed
Hauser, WA, Anderson, VE, Loewenson, RB, and McRoberts, SM. Seizure recurrence after a first unprovoked seizure. N Engl J Med. 1982;307(9):522–8.CrossRefGoogle ScholarPubMed
Foldvary-Schaefer, N and Unnwongse, K. Localizing and lateralizing features of auras and seizures. Epilepsy Behav. 2011;20(2):160–6.Google Scholar
Luders, H, Acharya, J, Baumgartner, C et al. Semiological seizure classification. Epilepsia. 1998;39(9):1006–13.Google Scholar
Fisher, RS, Cross, JH, French, JA et al. Operational classification of seizure types by the International League Against Epilepsy: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia. 2017;58(4):522–30.CrossRefGoogle ScholarPubMed
Fisher, RS, Cross, JH, D’Souza, C et al. Instruction manual for the ILAE 2017 operational classification of seizure types. Epilepsia. 2017;58(4):531–42.CrossRefGoogle ScholarPubMed
Lüders, H, Akamatsu, N, Amina, S et al. Critique of the 2017 epileptic seizure and epilepsy classifications. Epilepsia. 2019;60(6):1032–9.Google Scholar
Proposal for revised clinical and electroencephalographic classification of epileptic seizures. From the Commission on Classification and Terminology of the International League Against Epilepsy. Epilepsia. 1981;22(4):489501.Google Scholar
Gavvala, JR and Schuele, SU. New-onset seizure in adults and adolescents: A review. JAMA. 2016;316(24):2657–68.CrossRefGoogle ScholarPubMed
Annegers, JF, Hauser, WA, Beghi, E, Nicolosi, A, and Kurland, LT. The risk of unprovoked seizures after encephalitis and meningitis. Neurology. 1988;38(9):1407–10.Google Scholar
Annegers, JF, Hauser, WA, Coan, SP, and Rocca, WA. A population-based study of seizures after traumatic brain injuries. N Engl J Med. 1998;338(1):20–4.CrossRefGoogle ScholarPubMed
Barry, E, Krumholz, A, Bergey, GK et al. Nonepileptic posttraumatic seizures. Epilepsia. 1998;39(4):427–31.CrossRefGoogle ScholarPubMed
Peljto, AL, Barker-Cummings, C, Vasoli, VM et al. Familial risk of epilepsy: A population-based study. Brain. 2014;137(Pt. 3):795805.Google Scholar
Beleza, P. Acute symptomatic seizures: A clinically oriented review. Neurologist. 2012;18(3):109–19.Google Scholar
Sutter, R, Rüegg, S, and Tschudin-Sutter, S. Seizures as adverse events of antibiotic drugs: A systematic review. Neurology. 2015;85(15):1332–41.Google Scholar
French, JA and Pedley, TA. Clinical practice: Initial management of epilepsy. N Engl J Med. 2008;359(2):166–76.CrossRefGoogle ScholarPubMed
van Dijk, JG, Thijs, RD, van Zwet, E et al. The semiology of tilt-induced reflex syncope in relation to electroencephalographic changes. Brain. 2014;137(Pt. 2):576–85.Google Scholar
McKeon, A, Vaughan, C, and Delanty, N. Seizure versus syncope. Lancet Neurol. 2006;5(2):171–80.Google Scholar
Yanagihara, T, Piepgras, DG, and Klass, DW. Repetitive involuntary movement associated with episodic cerebral ischemia. Ann Neurol. 1985;18(2):244–50.CrossRefGoogle ScholarPubMed
Albadareen, R, Gronseth, G, Landazuri, P et al. Postictal ammonia as a biomarker for electrographic convulsive seizures: A prospective study. Epilepsia. 2016;57(8):1221–7.CrossRefGoogle ScholarPubMed
Burkholder, DB, Britton, JW, Rajasekaran, V et al. Routine vs extended outpatient EEG for the detection of interictal epileptiform discharges. Neurology. 2016;86(16):1524–30.CrossRefGoogle ScholarPubMed
Knake, S, Triantafyllou, C, Wald, LL et al. 3T phased array MRI improves the presurgical evaluation in focal epilepsies: A prospective study. Neurology. 2005;65(7):1026–31.Google Scholar
von Oertzen, J, Urbach, H, Jungbluth, S et al. Standard magnetic resonance imaging is inadequate for patients with refractory focal epilepsy. J Neurol Neurosurg Psychiatry. 2002;73(6):643–7.CrossRefGoogle ScholarPubMed
Fisher, RS, Acevedo, C, Arzimanoglou, A et al. ILAE official report: A practical clinical definition of epilepsy. Epilepsia. 2014;55(4):475–82.Google Scholar
Marson, A, Burnside, G, Appleton, R et al. The SANAD II study of the effectiveness and cost-effectiveness of levetiracetam, zonisamide, or lamotrigine for newly diagnosed focal epilepsy: An open-label, non-inferiority, multicentre, phase 4, randomised controlled trial. Lancet. 2021;397(10282):1363–74.Google ScholarPubMed
Marson, A, Burnside, G, Appleton, R et al. The SANAD II study of the effectiveness and cost-effectiveness of valproate versus levetiracetam for newly diagnosed generalised and unclassifiable epilepsy: An open-label, non-inferiority, multicentre, phase 4, randomised controlled trial. Lancet. 2021;397(10282):1375–86.Google ScholarPubMed
Perucca, E and Tomson, T. The pharmacological treatment of epilepsy in adults. Lancet Neurol. 2011;10(5):446–56.CrossRefGoogle ScholarPubMed
Tomson, T, Battino, D, Bonizzoni, E et al. Comparative risk of major congenital malformations with eight different antiepileptic drugs: A prospective cohort study of the EURAP registry. Lancet Neurol. 2018;17(6):530–8.CrossRefGoogle ScholarPubMed
Kwan, P and Brodie, MJ. Effectiveness of first antiepileptic drug. Epilepsia. 2001;42(10):1255–60.Google Scholar
Chen, Z, Brodie, MJ, Liew, D, and Kwan, P. Treatment outcomes in patients with newly diagnosed epilepsy treated with established and new antiepileptic drugs: A 30-year longitudinal cohort study. JAMA Neurol. 2018;75(3):279–86.CrossRefGoogle ScholarPubMed
Berg, AT and Shinnar, S. The risk of seizure recurrence following a first unprovoked seizure: A quantitative review. Neurology. 1991;41(7):965–72.CrossRefGoogle ScholarPubMed
Hart, YM, Sander, JW, Johnson, AL, and Shorvon, SD. National General Practice Study of Epilepsy: Recurrence after a first seizure. Lancet. 1990;336(8726):1271–4.Google Scholar
Fountain, NB and May, AC. Epilepsy and athletics. Clin Sports Med. 2003;22(3):605–16, xxi.Google Scholar
Pennell, PB, French, JA, Harden, CL et al. Fertility and birth outcomes in women with epilepsy seeking pregnancy. JAMA Neurol. 2018;75(8):962–9.Google Scholar
Krumholz, A, Hopp, JL, and Sanchez, AM. Counseling epilepsy patients on driving and employment. Neurol Clin. 2016;34(2):427–42, ix.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×