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Among patients presenting with first seizure (FS) to emergency department (ED), the challenge for the evaluating physician is to identify patients with acute symptomatic seizures. Formally, an acute symptomatic seizure is defined as a clinical seizure occurring at the time of a systemic insult or in close temporal association with a documented brain insult [1]. Pragmatically, acute symptomatic seizures are symptoms of a condition deserving immediate attention and treatment, such as stroke or central nervous system infection.