Abstract
Following a first seizure, it is important to establish whether this was an epileptic or non-epileptic seizure, and to ascertain possible cause of an epileptic seizure. With respect to further management, diagnostic or therapeutic, it is crucial to differentiate non-epileptic from epileptic seizures and to identify provoked epileptic seizures (acute symptomatic).
Patient history with a detailed description of the course of a seizure and circumstances under which it happened is instrumental in discriminating between the different types of seizures. Complementary investigations can further support the diagnostic process.
Acute symptomatic seizures represent up to 40% of all single epileptic seizures and occur in close chronological proximity to an ongoing central nervous system injury of various origins. The source can easily be identified - most frequently this is an acute cerebrovascular event, craniocerebral injury, inflammatory CNS disorder, while primarily extracerebral effects are also important - toxic and metabolic disorders and drug or alcohol abuse.
Unprovoked or reflex single epileptic seizures in patients with persisting predisposition and a high risk (> 60%) of relapse may, according to the new definition, be regarded as epilepsy and long-term antiepileptic treatment may be initiated. MRI under appropriate protocol should always be performed after the first unprovoked seizure.
The risk of seizure recurrence can be estimated based on patient history as well as any EEG or physical examination abnormity that suggests an injury of the CNS. Antiepileptic treatment is indicated in patients with a single seizure if there is a high risk of recurrence or an increased likelihood of severe complications of further seizures.