First ever epileptic seizures presenting 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. An epileptic seizure may be the first symptom of a life-threatening acute illness, an epilepsy syndrome or an isolated provoked event. On 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 doctors in training when managing adult patients with acute attacks.