First Unprovoked Seizure — Recurrence Risk
Estimates recurrence risk after a first unprovoked seizure to guide antiepileptic drug (AED) initiation discussion.
Score interpretation
Low risk of seizure recurrence after first unprovoked seizure.
→ DVLA: must not drive for 6 months after single seizure (notify DVLA). Discuss AED: not routinely recommended after first seizure in low-risk patients. Patient education. Safety advice: swimming, heights, baths (use showers). Epilepsy specialist review within 2 weeks (NICE QS27). Trigger review.
Moderate recurrence risk. Consider AED after shared decision-making.
→ Discuss risks/benefits of AED therapy. EEG + MRI brain if not done. AED initiation may reduce early recurrence but does not alter long-term prognosis. DVLA seizure driving rules apply. Neurology review within 2 weeks (NICE). Avoid seizure triggers.
High recurrence risk. AED treatment generally recommended.
→ Start AED after neurologist review: first-line depends on seizure type — sodium valproate (caution in women of childbearing age), levetiracetam, or lamotrigine for focal-onset. Counsel on valproate risks in pregnancy (MHRA alert). DVLA: no driving for 12 months after first seizure if AED started. Pregnancy planning if relevant.
Interpretation bands for the Seizure Recurrence. Apply clinical judgement and local guidance.
References
- NICE CG137. Epilepsies: diagnosis and management. 2012 (updated 2022).
- Berg AT, Shinnar S. The risk of seizure recurrence following a first unprovoked seizure: a quantitative review. Neurology. 1991.
Related
Curated clinical cross-links plus same-class fallbacks.
- Promethazine hydrochloride · First-generation H1-antihistamine (phenothiazine)
- Tolbutamide · First-generation sulfonylurea (short-acting)
- Chlorphenamine (Chlorpheniramine) · Sedating Antihistamine (H1 Antagonist — First-generation)
- Cyproheptadine hydrochloride · First-generation antihistamine + 5-HT₂A antagonist
- Sodium Valproate (Epilepsy in Elderly) · Antiepileptic
- Cefalexin · First-Generation Cephalosporin — Skin / Soft Tissue / UTI
- Acute Stroke / TIA Assessment · NICE NG128; RCP Stroke Guidelines 2023
- Status Epilepticus (Adults) · NICE CG137; ESEM guidelines; RCP Neurology Guidelines
- Suspected Subarachnoid Haemorrhage · NICE NG228; RCEM 2023; AHA/ASA 2023
- Adult Head Injury · NICE NG232 (2023)
- Bell's Palsy / Facial Nerve Palsy · ENT UK 2017; AAN
- Vertigo Workup · ENT UK; NICE CKS
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.