Challenges in the Diagnosis of Patients Presenting with the “First Seizure”

Objective: Epileptic seizures are paroxysmal events resulting from abnormal neuronal activity. Diagnosing a first seizure presents a significant clinical challenge, particularly in patients without a previous similar history. This study aims to evaluate the clinical approach to first seizures, which are often posing diagnostic and therapeutic challenges. Methods: This prospective study was conducted in a tertiary care hospital and included patients admitted to the emergency department and neurology outpatient clinic with suspected first seizures from January 2023 to March 2024. Patients were followed for at least one year. Data collected included age, gender, laboratory tests, cranial imaging, and electroencephalogram (EEG) results. Final diagnoses were classified as either “seizure” or “seizure mimics,” with seizures further categorized into “unprovoked” and “acute symptomatic.” The unprovoked category was divided into “true first seizure” and “recurrent seizure.” Results: A total of 210 patients were included in the study, with 152 diagnosed with seizures and 58 with seizure mimics. The mean age was 43.7 years. The male/female ratio was 55.3%/44.7%. In the “seizure” group, 119 patients (56.7%) had unprovoked and 33 (15.8%) had acute symptomatic seizures. In the unprovoked group, 106 patients (50.5%) were classified as having a true first seizure. Detailed history revealed that 13 patients (6.2%) had at least one similar seizure before. Seizure recurrence was observed in 27 patients (25.5%). Conclusion: This study highlights the diagnostic challenges of first seizures. Accurate differentiation between epileptic seizures and mimics is crucial. Comprehensive history and EEG are essential for optimizing treatment, and initiating therapy in true seizure cases effectively reduces the risk of recurrence.