Neurologic Conditions: New-Onset Seizures in Adults

Family physicians may be the first point of contact for adults with new-onset seizure. There are many etiologies of seizures in adults. Etiologies of provoked seizures include temporary metabolic disturbances, central nervous system infections, cerebrovascular disease, drug withdrawal, and traumatic brain injury. Stable or evolving cerebral conditions can cause unprovoked seizures. Nonorganic etiologies include nonepileptiform convulsions, such as a pseudoseizure, which are psychogenic. In the emergency department setting, computed tomography scan of the head should be considered for all patients with new-onset seizure. An electroencephalogram and magnetic resonance imaging study are recommended as further evaluation for an adult with a new-onset seizure unrelated to trauma, alcohol, or drugs. The occurrence of a single seizure does not always necessitate initiation of an antiepileptic drug. The risk of recurrent seizure should dictate the need for drug initiation. Patients should be counseled against driving until they have been seizure free for at least 3 months. Patients who are planning for pregnancy should be informed that antiepileptic drugs are potentially teratogenic.