Evaluation and management of first seizures in adults

Patients who have experienced an isolated afebrile seizure often present to a primary care physician. A detailed history and carefully performed physical examination aid the physician in determining whether the event was actually a seizure and whether it was the patient's first seizure. Because the decision to treat "labels" the patient, alters the patient's life and subjects him or her to potentially toxic drug side effects, this decision should be considered carefully by both the physician and the patient. Studies assessing the risks of recurrence, remission and relapse, as well as treatment strategies, provide objective data on which the primary care physician and the patient can base treatment decisions.