The first seizure and its management in adults and children

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Abstract
A first “grand mal” convulsion is frightening, yet prospective, population-based studies indicate that we all face an 8-10% lifetime risk of one seizure1 and a 3% chance of epilepsy.2 It seems likely that everyone could have a seizure if a particular set of circumstances occur—but some people have a lower seizure threshold than others. A first seizure caused by an acute disturbance of brain function (acute symptomatic or provoked) is unlikely to recur (3-10%). If a first seizure is unprovoked, however, meta-analyses suggest that 30-50% will recur; and after a second unprovoked seizure, 70-80% will recur, justifying the diagnosis of epilepsy (a tendency for recurrent seizures).3–5