ME3. First-onset seizures – An update on the concept and review of best practice

Abstract

The diagnostic work-up of a first seizure or seizure-like event (FS) is extremely important to determine rapidly its origin, the optimal therapy and prognosis. FS affect patients of all ages. Together with stroke, seizures are one of the most frequent neurological emergencies, associated with an increased morbidity and mortality. In order to obtain a proper diagnosis, EEG, MRI, and according to clinical hypothesis, other exams need to be carried out. It has been shown in several studies that the yield is higher if exams are carried out as early as possible. The prognosis and further adherence will crucially depend on the first contact. I will present evidence for these assumptions and examples of cases. The importance of precise diagnosis and efficient therapy has been recognized in prospective and retrospective studies, leading to evidence-based guidelines by the Academy of Neurology in 2015 (Krumholz Neurology, 2015) as well as several commissions inside the ILAE and IFCN. By 5 years or more, 50–70% present seizure recurrence, suggesting that antiepileptic drugs fail in the majority of patients. Reasons for drug failures need to be examined as well, as careful as the index event. In most centers, work-up in the emergency department (ED) includes often only a medical/neurological consultation, standard EEG and CT, leaving the organization of further exams to the discretion of the treating neurologist. Hopefully, a comprehensive and swift work-up after FS will become standard in centers around the world dealing with FS patients.