The main conclusion to be derived from the articles by Hauser1 and by Hart and Easton2 is that we really do not have accurate information regarding the chances of further seizures after a single first seizure. Therefore, the fairest and most ethical way to treat such patients is to share our uncertainty with them.
It is certainly more time consuming to thoroughly discuss what we do and what we do not know about the implications of positive or negative family history, normal or abnormal electroencephalograms, presence or absence of possible precipitating factors, and the like, but it is really the only fair way to proceed. The presence of epileptogenic activity in the electroencephalogram, a positive family history for epilepsy, or a history of febrile convulsions as a child certainly make it more likely that further seizures will occur. On the other hand, when a seizure occurs after
Fromm GH. First Seizure Management—ReconsideredResponse I. Arch Neurol. 1987;44(11):1189. doi:10.1001/archneur.1987.00520230069017