First seizures in adult patients are a common problem in clinical practice, and their management represents a challenge for physicians. The aim of this review is to develop a systematic clinical approach for the classification, diagnosis, and treatment of patients who have experienced a first seizure. This could help clinicians to recognize and treat this condition appropriately. Because these seizures can arise from several etiologies, it is essential to know if the event was a provoked (acute symptomatic) or unprovoked seizure. Thus, an adequate classification is important to establish the length of the diagnosis approach, the necessary treatment, and every individual prognosis. We found that patients diagnosed with a single unprovoked seizure require electroencephalography and magnetic resonance imaging. This will allow an assessment of the risk of recurrence and the identification of patients that follow the diagnosis criteria for epilepsy. We recommend individualized pharmacological therapy to reduce early seizure recurrence (≤ 2 years) even if it can produce some adverse effects. Finally, we determine that there are still certain areas of uncertainty to promote future research in this topic.
Jose de Jesus Vidal Mayo