First presenting seizures in adults

Epileptic seizures are common, and patients suffering a first seizure are often admitted to hospital as an emergency. Differentiating epileptic seizures from other types of attack can be difficult, and misdiagnosis has potentially serious consequences for the patient. Knowledge of the clinical features of epileptic seizures and what distinguishes them from dissociative (psychogenic) seizures, syncope and panic attacks is essential in guiding appropriate investigation and management. The first epileptic seizure may be the first symptom of a life-threatening acute illness, an epilepsy syndrome or a provoked event that never recurs. On the first presentation, patients need an accurate diagnosis, some immediate appropriate investigations, to be referred to the appropriate specialist and to receive correct advice regarding driving and work. This article addresses these aims and is intended to support junior doctors in managing adult patients with acute attacks.