It is estimated that 3.5% of people have one convulsive seizure in their lifetime and the prevalence of epilepsy is 0.5%. These two figures suggest that some people have only one seizure in their lifetime and this group of people cannot be diagnosed with epilepsy because epilepsy is defined as recurrent seizures. These numbers beg the question of whether regular antiepileptic treatment needs to be started immediately after the first seizure. The magnitude of the likelihood of recurrence after the first seizure is closely related to the need for treatment. Studies have been done specifically on recurrence after the first seizure, but because of differences in the study population and inconsistent length of follow-up, the results obtained vary widely, which is understandable, as the results of a study of 10 people may be completely different from those of 100 people, and the results of a 2-year versus 5-year follow-up may vary greatly. To summarize their study, 25-52% of patients relapsed within 2 years after the first episode, and the likelihood of relapse was 25%-71% if the follow-up period was long. In other words, about 1/4 to 3/4 of patients will have a second or multiple episodes after the first episode, and these patients should be considered for treatment with medication. The reason for this uncertainty is that there are other factors that cause easy recurrence, such as an EEG with epileptiform abnormalities after the first seizure is 1.5-3 times more likely to recur than a normal EEG, and a cause is 2 times more likely to recur than one without a cause. Wouldn’t it be simpler and easier to just use medication for seizures without considering all this? No, because medication for epilepsy takes a long time, at least 2-3 years of medication, and all medications have some adverse effects. So doctors can’t help but think more about patients who are less likely to have a recurrence and only have one seizure that is less damaging to them than the physical and psychological damage caused by long-term medication. Nowadays, it is generally agreed that if there is no cause for a seizure and no pathogen can be found, the EEG is normal and no medication can be used. If the EEG has epileptiform abnormalities, medication should also be started. If the conditions for no medication are met, a second seizure during follow-up and the interval between the first and second seizure is less than one year should be treated with medication. Conversely if the interval between the two is more than one year it is still possible to observe without medication, but this requires arguing for the family’s opinion, if the family is very afraid of a third seizure and they are psychologically prepared for the possible adverse effects of taking antiepileptic drugs, in which case regular medication can be started. In addition to the above conditions, a number of other situations should be examined. If, although it is the first seizure with neither an etiology nor a normal EEG, there is an epileptic among the siblings, such a patient has a very high possibility of recurrence and should be treated with medication. Some patients who have their first seizure can be temporarily treated without medication, but the nature of the patient’s job is special, such as working at height, working on water, electrician and contact with heavy machinery, etc. These jobs themselves do not affect whether the patient has a relapse, but in case the patient has a seizure at work that may have serious consequences and injure himself or even others, these patients should not hesitate to start medication. There is no mention here of the driver, who should not only be treated if he has a first attack, but should also be advised to stop driving the vehicle, as there are no legal provisions in this regard in the country, so he can only be discouraged. Imagine if the bus driver driving a vehicle to a busy road suddenly seized, the vehicle out of control, the consequences can be imagined. There is some consensus on whether medication is needed after the first attack, but each patient should be carefully examined in many ways to make the most correct choice.