Practice Guidelines

Unprovoked First Seizures in Adults: Management Recommendations from the AAN


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Am Fam Physician. 2015 Nov 1;92(9):835.

Key Points for Practice

• After an unprovoked seizure, the risk of recurrence is highest in the two years following the initial seizure.

• Risk factors for recurrent seizure include previous brain injury, epileptiform abnormalities found on electroencephalography, significant brain abnormality found on imaging, or nocturnal seizure

• The prognosis for sustained remission in the long term (greater than three years) is unlikely to be affected by immediate treatment with antiepileptic drugs.

From the AFP Editors

Diagnosis and management of unprovoked first seizures, which occur in approximately 150,000 adults in the United States each year, pose a challenge for physicians. Assessment, treatment, and prevention of recurrent seizures are key. This guideline from the American Academy of Neurology (AAN) provides information on prognosis and management options.


Physicians should counsel patients with an unprovoked first

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.

A collection of Practice Guidelines published in AFP is available at


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