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 ?.