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The diagnosis and management of suspected first seizures poses an important clinical challenge. A first seizure may signal the onset of new epilepsy, previously undiagnosed epilepsy, or a focal brain lesion. They may also represent important differentials such as psychogenic seizures. Following a single unprovoked seizure, the risk of recurrence is greatest in the first 3-6 months, prompting the development of national guidelines setting standards of care (1–3). The National Institute of Health and Care Excellence (NICE) have set recommendations for suspected first seizures and new epilepsy to be assessed within two weeks by an epilepsy specialist (4).