Approximately 150 000 adults present each year with an unprovoked first seizure in the United States, although less than half have a readily apparent cause.1 It is important to distinguish seizures from events that can mimic epilepsy, such as syncope, movement disorders, and toxic-metabolic encephalopathy, and recognize that transient factors that temporarily lower seizure threshold in an otherwise normal brain do not establish a diagnosis of epilepsy.2 Seizures can cause serious physical, psychological, and social consequences such as bodily injury, anxiety, loss of driving privileges, limitations on employment, and occasionally even death. For a patient with an unprovoked first seizure, the risk of seizure recurrence poses major concerns and raises the question of whether immediate AED therapy is advisable.
Tao JX, Davis AM. Management of an Unprovoked First Seizure in Adults. JAMA. 2016;316(15):1590-1591. doi:10.1001/jama.2016.12047