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After diagnosing an epileptic seizure, a distinction must be made between an acute symptomatic and an unprovoked seizure, since they have different treatments and prognosis. History, physical examination and other examinations (laboratory and imaging) are paramount in this distinction. After the diagnosis of a first unprovoked seizure, an EEG should be requested which may aid in establishing the diagnosis, evaluating the recurrence risk or ascertaining the self\u2010limited nature of the seizure. 3T\u2010MRI with an epilepsy protocol can be considered when CT has not clarified the aetiology. The decision to treat should be discussed with the patient\/relatives, taking into account the risk of recurrence, the clinical characteristics (aetiology, seizure type, age, job, epileptic seizure schedule, comorbidities and polymedication), probability of AED side effects, and stigmatization. Nowadays, the chosen regimen is usually monotherapy with a second\u2010generation AED that better suits the patient's characteristics, comorbidities and concurrent medication. Counselling should include first aid, precipitating factors, sport and physical exercise in order to avoid possible driving restrictions, the need for therapy compliance, and risk of recurrence and SUDEP.<\/jats:p>","DOI":"10.1684\/epd.2021.1296","type":"journal-article","created":{"date-parts":[[2021,7,29]],"date-time":"2021-07-29T13:02:14Z","timestamp":1627563734000},"page":"537-551","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Management of a first unprovoked epileptic seizure in adolescence and adulthood"],"prefix":"10.1002","volume":"23","author":[{"given":"Ana","family":"Catarina Franco","sequence":"first","affiliation":[{"name":"EEG\/Sleep Lab and Neurophysiology Monitoring Unit, Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria Centro Hospitalar e Universit\u00e1rio Lisboa Norte (HSM\u2010CHULN)"},{"name":"Department of Neurosciences and Mental Health (Neurology) 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