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JAMA Clinical Guidelines Synopsis
October 18, 2016

Management of an Unprovoked First Seizure in Adults

Author Affiliations
  • 1University of Chicago, Neurology, Chicago, Illinois
  • 2University of Chicago, Section of General Internal Medicine, Chicago, Illinois
JAMA. 2016;316(15):1590-1591. doi:10.1001/jama.2016.12047

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.