Initial management of seizure in adults

• The clinical diagnosis of an epileptic seizure requires a detailed history taking and, ideally, an eyewitness account of the seizure. • Evaluation with 12-lead electrocardiography is essential in a patient who has had a first seizure or an unexplained blackout spell. • In children and teenagers, interictal electroencephalography, ideally within 24 hours after a first seizure, is particularly important. • All patients who have had a suspected focal-onset seizure should undergo detailed magnetic resonance imaging of the head. • Patients who have had an epileptic seizure should be informed about factors that may provoke seizures (e.g., sleep deprivation and alcohol use), the risk of a seizure occurring while driving or engaging in solitary activities, and the risks of harm from further seizures. • Data from long-term pragmatic trials suggest that the first-line medication for patients with focal-onset seizures is either lamotrigine or levetiracetam, although other reasonable options are available; for patients with generalized-onset seizures, the first choice is sodium valproate, except for women of childbearing potential, in whom the first-line medication is usually levetiracetam