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First seizure presentations in adults: beyond assessment and treatment
  1. Emma Foster1,2,
  2. Patrick Carney3,4,
  3. Danny Liew5,
  4. Zanfina Ademi5,
  5. Terry O’Brien1,2,
  6. Patrick Kwan1,2
  1. 1 Neurology, Alfred Health, Melbourne, Victoria, Australia
  2. 2 Central Clinical School, Monash University, Melbourne, Victoria, Australia
  3. 3 Department of Medicine, Eastern Health, Melbourne, Victoria, Australia
  4. 4 Neuroscience and Mental Health, Florey Institute, Parkville, Victoria, Australia
  5. 5 School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  1. Correspondence to Dr Emma Foster, Monash University Central Clinical School, Melbourne, VIC 3800, Australia; emma.foster{at}


Almost 10% of people will experience at least one seizure over a lifetime. Although common, first seizures are serious events and warrant careful assessment and management. First seizures may be provoked by acute or remote symptomatic factors including life-threatening metabolic derangements, drug toxicity or structural brain lesions. An unprovoked first seizure may herald the onset of epilepsy and may be accompanied by medical and psychiatric illnesses. Accidents, injuries and death associated with first seizures are likely under-reported. The cognitive and emotional impact of first seizures is often neglected. Evaluation of a patient presenting with a first seizure requires careful history-taking and early specialist assessment, however optimal management strategies have not been extensively investigated. Further, advances in technology and the role of eHealth interventions such as telemedicine may be of value in the care of patients who have experienced a first seizure. This article reviews the impact and implications of first seizures beyond the scope provided in current guidelines which tend to focus on assessment and management. It examines the effect of first seizures on the well-being of patients; assesses morbidity and premature mortality in first seizures and discusses current and future directions to optimise safety and health of people with first seizures, with a focus on adult patients. Recognition of these issues is essential to provide adequate care for people with first seizures.

  • epilepsy
  • EEG
  • depression
  • migraine
  • MRI

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  • Contributors EF is the guarantor, contributed to the design and literature review, conceptualised the study and drafted the manuscript for intellectual content. PC, Dl, ZA, TO'B and PL revised the manuscript for intellectual content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests EF is supported by the National Health and Medical Research Council Postgraduate Scholarship, The Royal Australian College of Physicians Research Entry Scholarship, AVANT Doctor In Training Research Scholarship. PK is supported by the Medical Research Future Fund Practitioner Fellowship. PC, DL, ZA and ToB declare no support from any organisation for the submitted work. Further, authors declare no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, and no other relationships or activities that could appear to have influenced the submitted work.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.