First episode of epilepsy

The first seizure of epilepsy cannot always be considered by epileptologists as the debut of epilepsy. Many different diseases lead to the development of a condition similar to the first episode of epilepsy.   

Let us examine the most common options that occur at a neurologist’s appointment when patients are treated with an episode similar to epilepsy.

According to statistics, a single epileptic seizure can be transferred by every twentieth person. 5% of people in the entire population have experienced one typical epileptic-like seizure. But then the second attack may never happen.     

An attack can be triggered by various factors: high fever, intoxication, alcohol, electric shock, sleep deprivation, stress, metabolic disorders, overwork, prolonged TV viewing or computer activities. Such a single paroxysm, we call “situationally conditioned”. Such attacks can be repeated further, but they are of non-epileptic origin. They can be difficult to distinguish from epilepsy. After all, seizures with epilepsy can also be triggered by the same factors. 

After the first seizure, it is required to contact an epileptologist and conduct an examination to identify its cause.    

The possible range of diseases in which there may be one or more seizures is wide. These conditions include toxic, metabolic, post-traumatic, infectious or organic brain damage.

And, of course, in the first place, this single seizure is considered by neurologists as the beginning of epilepsy. 

It is required to accurately and in detail describe the first seizure of epilepsy: 

• date, time;
• what the patient was doing before;
• the sequence of the event;
• how it looked from the outside;
• what the person himself felt;
• what happened immediately after the attack;
• whether an ambulance was called;
• whether the attack stopped on its own or after the administration of drugs;
• whether he was hospitalized;
• examination results;
• examination of the provided medical documents;
• how he felt for the next hours and days;
• have you got sick (for example, ARVI).

The cause of the first non – epileptic seizure, similar to epilepsy, may be pathology: 

• convulsive syndrome in various diseases (for example, trauma, cerebral hemorrhage, infections),
• fainting with VSD,
• heart rhythm disturbances (paroxysmal tachycardia, extrasystole),
• transient disorders of cerebral circulation,
• apnea in children (for example, with aspiration of saliva),
• myoclonus of non-epileptic origin (for example, in the form of facial muscle contraction, eyeballs),
• parasomnias (sleep disorders of non-epileptic origin, sleepwalking , sleep- speaking ),
• benign dizziness,
• essential tremor,
• headaches of various origins,
• migraine,
• affective-respiratory syndrome,
• abdominal pain of various origins,
• neurotic reactions,
• mental illness,
• and many other conditions.

At the appointment, after a detailed questioning of the patient and witnesses of the seizure, in order to clarify the origin of a single seizure similar to an epileptic, the doctor will determine the need for additional examination methods :    

• electroencephalography (background or as indicated by sleep EEG, EEG video monitoring),
• imaging with magnetic resonance imaging (MRI) or computed tomography (CT) of the brain.

For diagnosis after the first seizure of epilepsy , it may be necessary to carry out such additional research methods as: 

• general blood analysis,
• general urine analysis,
• blood chemistry,
• including a blood sugar test,
• electrocardiography (ECG),
• cardiointervalography (CIG),
• ultrasound examination (ultrasound) of the heart,
• Ultrasound of internal organs.

Also, at the first seizure of epilepsy, to exclude or confirm the diagnosis, it may be necessary to consult a specialist:  

• psychiatrist,
• psychologist,
• endocrinologist,
• neurosurgeon,
• gastroenterologist,
• genetics,
• urologist,
• pulmonologist,
• cardiologist,
• otolaryngologist,
• ophthalmologist,
• infectious disease specialist
• and others.

Not all of these research methods and consultations of all these doctors are required for every person who has had the first epileptic seizure. The scope of the examination is determined by the epileptologist , gives directions and orientates where and how the patient can be further examined.

In the event that the clinical manifestations of the first seizure were typical for a certain form of epilepsy , and there is also a clear epileptiform activity on the EEG, the MRI data do not contradict this form of epilepsy, there is a hereditary burden, there are focal neurological symptoms (for example, paresis), there are intellectual and behavioral disorders, one can think of the onset of epilepsy. All these manifestations can be in varying degrees of severity and in different combinations. Only if the doctor has exact confidence based on these factors, then after the first seizure it is possible to diagnose epilepsy , taking into account its form according to the international classification.     

And then the question will arise: “Whether to treat epilepsy after the first seizure?”  

After carrying out the necessary research methods after the first seizure, as with epilepsy , the possible options are Diagnoses:   

1. A single epileptic seizure.
2. A single epileptic seizure, the debut of epilepsy (indicating the form according to the classification).
3. Epileptic encephalopathy, with cognitive and behavioral impairment, a single seizure.
4. Convulsive syndrome in other diseases. 
5. Paroxysm of non-epileptic genesis (with specification of the disease).
6. Conversion disorder.
7. Parasomnias .
8. Lots of other options.

And the tactics of treating these diseases are different, often completely opposite. And the earlier epilepsy is diagnosed , the earlier rational treatment is prescribed, the better the prognosis for recovery. This is why it is so important to get the correct diagnosis right after the first episode of epilepsy. 

So, from the article we learned that the first seizure of epilepsy requires a mandatory visit to a neurologist, who, after carefully studying the nature of the paroxysm, can determine the list of examinations, identify the cause, and make the correct diagnosis. The cause of the first seizure, similar to epilepsy, can be many diseases that need to be treated with other methods.   

And remember that epilepsy is 70% curable.