First seizure in an adult (patient seen after the seizure)
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
First seizure, back to baseline
In the practice
- Capillary blood glucose; 12-lead ECG (long QT, arrhythmia).
Laboratory tests
- Serum electrolytes
- Serum calcium
- Serum creatinine with eGFRif neededThe SFN recommendation (2014, HAS-endorsed) includes urea and serum creatinine in the work-up of a first seizure, with capillary glucose and serum electrolytes (grade C) [2]; the HAS (2020) retains only glucose, electrolytes and serum calcium [3]. Urea is reimbursed in France only if acute renal failure is suspected, in dialysis or for nutritional assessment of chronic renal failure [4].
- Serum β-hCG (in women of childbearing potential)if needednon-French guidelineAn American Family Physician review (2012) recommends a pregnancy test in every woman of childbearing potential after a first seizure, as pregnancy can unmask an epileptic focus (consensus, level of evidence C) [5]. The HAS does not cite it in the routine tests for a first seizure (capillary glucose, serum electrolytes, serum calcium) [3].
- Neurology consultation within 15 days; EEG as early as possible (ideally within 24 hours); brain MRI within the month if the examination is normal.
Also consider
Do not order
- Lactate and CK to “prove” the seizure or to distinguish it from convulsive syncope: no expert agreement in their favour; no laboratory test makes the diagnosis of an epileptic seizure [3]
- Routine measurement of toxic substances, drugs or blood alcohol: not recommended outside a medico-legal context [2]
Sources (6)
- Société française de neurologie. Prise en charge d'une première crise d'épilepsie de l'adulte. Recommandations de bonne pratique (label HAS, octobre 2014).
- Société française de neurologie. Prise en charge d'une première crise d'épilepsie de l'adulte. Recommandations de bonne pratique, label de la Haute Autorité de santé (octobre 2014, mise en ligne janvier 2015).
- Haute Autorité de santé. Épilepsies : prise en charge des enfants et des adultes. Recommandation de bonne pratique, validée par le Collège le 8 octobre 2020.
- Assurance maladie. Nomenclature des actes de biologie médicale (NABM), version 105 : acte 0591 (urée).
- Wilden JA, Cohen-Gadol AA. Evaluation of first nonfebrile seizures. Am Fam Physician. 2012;86(4):334-340.
- National Institute for Health and Care Excellence (NICE). Epilepsies in children, young people and adults. Guideline NG217, avril 2022, mise à jour 5 août 2026.