Patient handout

First Unprovoked / New-Onset Seizure Evaluation (adult)

PRODUCTION

1. Your condition

This handout is for first unprovoked / new-onset seizure evaluation (adult). Your care team identified this based on: first lifetime witnessed convulsive event — is-it-a-seizure work-up (aan/aes 2015 krumholz pmid 25901057).

Other reasons your team may use this plan: transient loss of consciousness of uncertain cause — seizure vs syncope vs pnes (sheldon point score pmid 12103268); new focal aware / focal impaired-awareness episode (déjà vu, automatisms, sensory aura) — ilae 2017 classification (scheffer pmid 28276062); post-event prolonged confusion or todd paresis after a paroxysmal event (post-ictal pivot — king pmid 9759742).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
no ASM — observe with safety-net + driving/safety counselling	—	—	—	AAN/AES 2015 (Krumholz PMID 25901057) + MESS (Marson Lancet 2005 PMID 15950714) — immediate ASM reduces 2-yr recurrence but does NOT improve long-term remission/QoL; defer is reasonable when recurrence risk low and patient values favour it
start ASM — epilepsy diagnosed (recurrence risk ≥60% OR ≥2 unprovoked >24 h apart OR epilepsy syndrome)	—	—	—	ILAE 2014 operational definition (Fisher PMID 24730690) — epilepsy can be diagnosed after ONE seizure when 2-yr recurrence ≥60% (e.g., remote symptomatic + epileptiform EEG); treat as epilepsy

Plan: First unprovoked seizure — ASM selection by seizure type + childbearing-potential branch (AAN/AES 2015 Krumholz PMID 25901057; NICE NG217 2022; SANAD II)

3. When to call your provider

Contact your care team if any of the following happen:

Second unprovoked seizure >24 h after first → epilepsy diagnosed (ILAE 2014 Fisher PMID 24730690) → start/optimise ASM
Recurrent or prolonged seizure → ED; if ≥5 min → SE pathway (route neuro.status-epilepticus.core.v1)
Suspected PNES → video-EEG + psychiatry referral (do NOT escalate ASM)
PHQ-9 ≥15 or suicidal ideation → urgent psychiatry (ASM suicidality signal)
Pregnancy declared on valproate → urgent specialist review + ASM switch planning

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Continuous seizure ≥5 min OR recurrent seizures without recovery to baseline (ILAE 2015 operational definition of status epilepticus)(life-threatening)
New focal neurological deficit OR persistent altered mental status after the event — acute-symptomatic structural/infectious cause
Hypoglycaemia, severe hyponatraemia, hypocalcaemia, uraemia/hepatic, OR pregnancy ≥20 wk / postpartum (eclampsia) — immediately reversible provoking cause

5. Follow-up

Driving-restriction counselling (jurisdiction-dependent — counsel AND document), safety (swimming/heights/bathing/occupational), SUDEP discussion, alcohol/sleep-deprivation trigger avoidance, ASM individualisation, pregnancy planning + folate for childbearing potential, re-evaluate epilepsy diagnosis if second seizure (AAN/AES 2015 Krumholz PMID 25901057; ILAE 2014 Fisher PMID 24730690)

6. Sources

Guideline: AAN/AES 2015 Evidence-Based Guideline — Management of an Unprovoked First Seizure in Adults (Krumholz, Neurology 2015) + ILAE 2014 Operational Definition of Epilepsy (Fisher, Epilepsia 2014) + NICE NG217 (2022) Epilepsies + ILAE 2017 Classification (Scheffer, Epilepsia 2017) + MESS (Marson, Lancet 2005) + FIRST Seizure Trial