[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-625597-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-625597-en":130},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","first-seizures-acute-repetitive-seizures-and-status-epilepticus","First Seizures, Acute Repetitive Seizures, and Status Epilepticus","","Current evidence on management timing and approaches for unprovoked first seizures in children and adults, including guidance on dosing and selecting modern effective therapies for acute repetitive (cluster) seizures. Reviews diagnostic and management evidence for established, refractory, and super-refractory status epilepticus. Highlights latest developments on AI as a decision-support assistant and discusses treatment equipoise in nonanoxic convulsive refractory cases, including escalation options.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/first-seizures-acute-repetitive-seizures-and-status-epilepticus/625597/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/first-seizures-acute-repetitive-seizures-and-status-epilepticus/625597.png","ImageObject",300,407,{"name":42,"@type":43},"Liam","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-13","2026-10-20",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",10,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What is the estimated risk of a second seizure after a first unprovoked seizure?","Question",{"text":63,"@type":64},"The risk is about 36% at 2 years and 46% after 5 years. The risk increases further with EEG epileptiform discharges, brain imaging abnormalities, a nocturnal first seizure, or prior brain trauma.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How should acute repetitive (cluster) seizures be initially treated?",{"text":68,"@type":64},"Provide a proper dose of benzodiazepines based on the patient’s weight and needs.",{"name":70,"@type":61,"acceptedAnswer":71},"What are the recommended first- and second-phase treatments for convulsive established status epilepticus?",{"text":72,"@type":64},"First phase: immediate administration of full doses of benzodiazepines. Second phase: full loading dose of IV fosphenytoin, levetiracetam, valproic acid, or if necessary, phenobarbital.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},625597,1792620080,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,120,123,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":116,"doc_module":4,"doc_module_name":25,"category_name":117,"show_sort_weight":118,"slug":119},9,"Religion & Spirituality",20,"religion-spirituality",{"id":118,"doc_module":4,"doc_module_name":25,"category_name":121,"show_sort_weight":118,"slug":122},"World Cup","world-cup",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":55,"slug":125},"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":97,"slug":129},19,"General","general",{"code":4,"msg":82,"data":131},{"doc_id":79,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":113,"language":139,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":12,"update_tm":143,"read_time":144,"preview_page_count":4},8796095461564,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Downloaded from [https://continuum.aan.com by Hebrew University of Jerusalem-Israel on 24 June 2026](https://continuum.aan.com by Hebrew University of Jerusalem-Israel on 24 June 2026)  \nFirst Seizures, Acute Repetitive Seizures, and Status Epilepticus  \nBy David G. Vossler, MD, FAAN, FACNS, FAES  \nABSTRACT  \nOBJECTIVE: This article provides current evidence on how and when to treat unprovoked first seizures in children and adults, guides intervention with appropriate doses and types of modern and effective therapies for acute repetitive (cluster) seizures, and reviews evidence for the diagnosis and management of established, refractory and super-refractory status epilepticus.  \nLATEST DEVELOPMENTS: Artificial intelligence shows promise as a clinical assistant in decision making after a first seizure. For nonanoxic convulsive refractory status epilepticus third-phase treatment, equipoise exists regarding whether it is better to add a second IV nonsedating antiseizure medication given via loading dose (eg, brivaracetam, lacosamide, levetiracetam, fosphenytoin or valproic acid) or to start an anesthetizing continuous IV infusion antiseizure medication such as ketamine, midazolam, propofol or pentobarbital.  \nESSENTIAL POINTS: After a first seizure, the risk of a second seizure is about 36% at 2 years and 46% after 5 years. The risk is doubled in the presence of EEG epileptiform discharges, a brain imaging abnormality, a nocturnal first seizure, or prior brain trauma. For acute repetitive seizures, providers should give a proper dose of benzodiazepines based on the patient’s weight and needs. First-phase treatment for convulsive established status epilepticus is the immediate administration of full doses of benzodiazepines. Second-phase treatment for convulsive established status epilepticus is a full loading dose of IV fosphenytoin, levetiracetam, valproic acid, or if necessary, phenobarbital.  \nINTRODUCTION  \nE  \nmergency treatment may be necessary after a person’s first seizure or at the onset of abnormal acute repetitive (cluster) seizures. It is required for status epilepticus. These emergencies can arise at home, in public, or in health care settings and can lead to serious complications, including death. Treatment for these emergencies is dictated by myriad  \nclinical factors and informed by national and international published guidance as well as emerging research.1-6 All diagnostic tests and treatments mentioned in this article may not be available in all areas of the world.  \nREVIEW ARTICLE  \n􀀁  \nCONTINUUM AUDIO INTERVIEW AVAILABLE ONLINE  \nCITE AS:  \nCONTINUUM (MIN NEA P M INN) 2025;31(1, EPILEPSY):95–124.  \nAddress correspondence to Dr David G. Vossler, 4764 155th Pl SE, Bellevue, WA, 98006, [dgvossler@msn.com](dgvossler@msn.com).  \nRELATIONSHIP DISCLOSURE: Dr Vossler has received personal compensation in the range of $0 to $499 for serving asa consultant for Biohaven Ltd;  \nin the range of $500 to $4999 for serving as a consultant for Biocodex, serving on a scientific advisory or data safety Continued on page 124  \nUNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE:  \nDr Vossler discusses the unlabeled use of adrenocorticotropic hormone, brivaracetam, diazepam, fosphenytoin, intravenous immunoglobulin (IVIg), ketamine, lacosamide, levetiracetam, lorazepam, magnesium sulfate, methylprednisolone succinate, midazolam, pentobarbital, phenobarbital, propofol, pyridoxine, and valproic acid for first seizures, acute repetitive seizures, and status epilepticus.  \n© 2025 American Academy of Neurology.  \nCONTINUUM JOURNAL . COM 95  \nCopyright © American Academy of Neurology. Unauthorized reproduction of this article is prohibited.  \nFIRST SEIZURES, ACUTE REPETITIVE SEIZURES, AND STATUS EPILEPTICUS  \nDownloaded from [https://continuum.aan.com by Hebrew University of Jerusalem-Israel on 24 June 2026](https://continuum.aan.com by Hebrew University of Jerusalem-Israel on 24 June 2026)  \nFIRST SEIZURE  \nMost first seizures ar","cbCaieEaHWgGtrAI","https://ap.wps.com/l/cbCaieEaHWgGtrAI","pdf",14545313,"English","# ABSTRACT\n## Objective\n## Latest Developments\n## Essential Points\n# INTRODUCTION\n# Treatment\n## First Seizure\n# REVIEW ARTICLE","[{\"question\":\"What is the estimated risk of a second seizure after a first unprovoked seizure?\",\"answer\":\"The risk is about 36% at 2 years and 46% after 5 years. The risk increases further with EEG epileptiform discharges, brain imaging abnormalities, a nocturnal first seizure, or prior brain trauma.\"},{\"question\":\"How should acute repetitive (cluster) seizures be initially treated?\",\"answer\":\"Provide a proper dose of benzodiazepines based on the patient’s weight and needs.\"},{\"question\":\"What are the recommended first- and second-phase treatments for convulsive established status epilepticus?\",\"answer\":\"First phase: immediate administration of full doses of benzodiazepines. Second phase: full loading dose of IV fosphenytoin, levetiracetam, valproic acid, or if necessary, phenobarbital.\"}]","First Seizures, Acute Repetitive Seizures, and Status Epilepticus | PDF",1792531749,76]