Evidence-based Guideline: Management of an Unprovoked First Seizure in Adults

An estimated 150,000 adults present annually with an unprovoked first seizure in the United States. Even one seizure is a traumatic physical and psychological event that poses difficult diagnostic and treatment questions, and has major social consequences (e.g., loss of driving privileges, limitations for employment). Recurrent seizures pose even more serious and costly problems. Therefore, optimal evidence-based approaches for evaluating and managing adults after a first seizure and preventing recurrences with antiepileptic drug (AED) therapy are important. A 2007 practice guideline addresses the evaluation of an unprovoked first seizure in adults3; the present practice guideline analyzes evidence regarding prognosis and therapy.