Diagnosis Protocol

Clinicians should inform the patient that the chance for a recurrent seizure is greatest within the first 2 years (21%–45%), with the highest risk in the first year (32% at 1 year, compared with 46% by 5 years).

Clinicians should identify if there was a prior brain insult or lesion (e.g., stroke, trauma, CNS infection, cerebral palsy, cognitive developmental disability) judged to be the cause of the seizure (remote symptomatic seizure).

The risk of recurrence is approximately 2-fold higher, with cumulative incidence rates of 26%, 41%, and 48% at 1, 3, and 5 years, respectively.

An EEG should be performed to check for epileptiform abnormalities (spikes or sharp waves).

The risk of seizure recurrence is significantly increased (relative rate increase of 2.16; 95% CI 1.07–4.38).

Significant brain-imaging abnormalities (MRI or CT) judged to be the cause of the seizure should be identified.

The hazard ratio for seizure recurrence is increased to 2.44 (95% CI 1.09–5.44).

The clinician should determine if the seizure was nocturnal.

The risk for recurrence is increased (odds ratio 2.1; 95% CI 1.0–4.3) compared to seizures occurring while awake.

The patient's age, sex, family history of seizures, seizure type, and presentation with status epilepticus or multiple discrete seizures within 24 hours are not consistently associated with increased recurrence risk.