Abstract
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.
Highlights
Seizures are a common problem in clinical practice being responsible for about 1% of hospital admissions and 3% of emergency room visits [1]
In both trials it was found that the risk of seizure recurrence at 2 years was 50% less in the group of patients who had immediate Antiepileptic Drugs (AED) therapy, but there was no impact on long-term remission rate of these patients [52,77,78]
A prospective study by Lawn et al reported that after the first seizure, a freedom seizure interval of 12 weeks reduced the initial risk of seizure recurrence of those patients; in other words, that the risk of seizure recurrence was time-dependent [96]
Summary
Seizures are a common problem in clinical practice being responsible for about 1% of hospital admissions and 3% of emergency room visits [1]. An epileptic seizure is a transient event of signs or symptoms due to abnormally excessive or synchronous neuronal activity in the brain [2]. A convulsion is the motor manifestation of this abnormal neuronal activity [3]. It is essential to perform a correct classification of the patients event because it establishes the management and prognosis. The aim of this review is to develop a systematic clinical approach for the classification, diagnosis, and treatment of these patients to help clinicians recognize and treat this condition appropriately
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