The evaluation of a first seizure involves confirming the event, diagnosing the cause, and deciding on appropriate antiepileptic drug treatment based on a risk-benefit discussion.
Guides individualized first-seizure evaluation and treatment decisions; leaves open prospective validation of diagnostic algorithms.
The first step in evaluation of a presumed seizure is to determine whether the event was indeed a seizure and which diagnostic studies are needed. The second step is to correctly diagnose the seizure on the basis of the medical history and findings from the physical, neurologic, and laboratory evaluation. The third step is to decide whether drug treatment is necessary. Every paroxsymal event is unique, and not every seizure needs to be treated. When treatment is deemed appropriate, an antiepileptic drug should be chosen after discussion with the patient and consideration of the risk-benefit profile of the available agents.
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Prego-Lopez et al. (2002) studied this question.
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