[Management of a first epileptic seizure in adults]

Management of a first seizure is a frequent challenge in the emergency room. Definite diagnosis is mandatory before treatment, identification of the epileptic syndrome is recommended. The overall recurrence rate of a first unprovoked seizure is about 50%, but varies considerably depending on several risk factors (neurological deficit in particular, a congenital one, Todd's paralysis, significant psychiatric disorders, epilepsy in siblings, symptomatic seizures (MRI is the standard procedure now to detect a structural lesion, except in case of a idiopathic generalised epilepsy and epilepsy with centro-temporal spikes) and epileptiform abnormalities on EEG which should be obtained within 24 hours after a seizure. Each treatment decision has to be taken individually after discussion with the patient. Early treatment reduces the 2 years recurrence rate but doesn't alter the long term prognosis.