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November 1987

First Seizure Management—Reconsidered: Response III

Author Affiliations

From the University of Pittsburgh Epilepsy Center.

Arch Neurol. 1987;44(11):1190-1191. doi:10.1001/archneur.1987.00520230070019

This article is in response to a recent CONTROVERSIES IN NEUROLOGY1 dealing with the question of the appropriate treatment of a person who has a single seizure. Although considerable epidemiologic information was given in the original series of articles, I would like to propose a different risk/ benefit analysis to the situation and outline one epileptologist's approach to the problem.

When a person presents to the doctor after having had a "spell," it is incumbent on the physician to arrive at the appropriate diagnosis. In diagnosing a seizure and/or epilepsy, I refer to the International Classification of Seizures2 and a recently published classification of epilepsy3 as a guideline. The history of the event obtained from the patient and an observer will produce an accurate diagnosis 95% of the time. The occurrence of a single primarily generalized convulsive seizure may be due to exogenous events such as

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