A prospective cohort study of 127 children aged 1 month through 17 years seen in the First Seizure clinic at the Alberta Children's Hospital between Jan 1, 2004 and August 30, 2005 determined the range of diagnoses and the prevalence of previous unrecognized seizures. The diagnosis was epileptic in 94 (74%), nonepileptic in 31 (24%) and unclassified in two (2%). Pediatricians referred true epileptic events in 92% cases, ED physicians 76%, and family physicians 65%. Mean age at presentation was 8 years. Development was delayed in 15%; the neurologic examination was abnormal in 11%. True epileptic seizures were generalized in 32 (34%) and partial in 62 (66%). Fifteen (16%) had an epilepsy syndrome. Over a 1-year follow-up period, 42 (45%) children presenting with an epileptic seizure were diagnosed with epilepsy (recurrent seizures). A prior probable seizure in 38% was recognized by the referring physician in only one case. Unrecognized events included: absence seizure (2), myoclonic (5), and partial complex (8). An EEG obtained in all children with seizures was abnormal in 41%. EEGs obtained early (<48 hours) showed abnormalities in 47% compared to 44% of those obtained late (>48 hours), with no significant difference. 
COMMENT. Diagnostic inaccuracies in children with “first seizures” are common in general practice, one quarter of patients incorrectly diagnosed has having a seizure rather than a nonepileptic event, while a diagnosis of epilepsy is missed in over one-third. The authors recommend that children with a first seizure should be seen by a neurologist.