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Special considerations for a first seizure in childhood and adolescence

Children with a first unprovoked seizure almost always present with a convulsive seizure. The differential diagnosis includes many paroxysmal events, especially convulsive syncope but even with a good history; there is often uncertainty that cannot be eliminated by investigations. In general, an EEG and MRI are indicated with other investigations determined on a case‐by‐case basis. Epilepsy syndrome identification may be very valuable. Current literature allows at least partial answers to parents' six most common questions: Will it happen again? How long do I have to wait for a recurrence? Could my child die during a recurrence? Could there be brain damage with a recurrence? If medication treatment is delayed will there be any long‐term change in the chance of a permanent remission? Now that my child has had a seizure, how should his/her activities be restricted?