Abstract
In acute period after the first seizure - loss of consciousness with convulsions with suspicion on GTCS - it is emphasized to distinguish epileptic and nonepileptic origin (mostly convulsive syncope) and identify an acute disorder, which can cause provoked seizure. Later on it is highly desirable to disclose appearance of inconspicuous seizures of other type, e.g. myoclonia, absences, focal seizures, in patient history as it can prove diagnosis of epilepsy.
CT scan is always recommended as soon as possible, MRI can be delayed. Except for abnormal neurological findings, EEG abnormality - both nonspecific slowing and specific epileptiform changes - increases risk for seizure recurrence.
Initiation of antiepileptic therapy after first unprovoked seizure is reasonable when there is a high risk of recurrence or complications of seizure.