[Management of the first convulsive seizure]

OBJECTIVE: To observe the wide variety of reported prognosis after a first unprovoked convulsion and of risk factors that are associated with recurrence, and a uniform conduct. SOURCES: Systematic review of Bireme. SUMMARY OF THE FINDINGS: Recurrence rates differ from a first seizure study because of different inclusion criteria. The EEG is particularly helpful to support the epileptic nature of the event in younger patients and in those with seizures of unknown origin. An abnormal EEG, particularly the ones with generalized spike-wave discharges, has been reported as a consistent predictor of recurrence. Although not a substitute for the clinical examination, the EEG is an integral part of the diagnostic process after the first afebrile seizure and should be requested. The actual decision regarding whether or not to treat patients who present an initial seizure depends heavily on the physiciańs assessment of the potential morbidity of another seizure versus the potential morbidity of antiepileptic drugs (AEDs) therapy. CONCLUSIONS: In children, side effects of AEDs are common, and the risk of injury from a seizure is usually minimal because children neither drive nor operate heavy machinery and are usually in supervised environment. Regarding adults, there is little unanimity.