First seizures are a common and important problem, affecting over 14,000 Australians each year, or almost 10% of people over their lifetime. First seizures are associated with increased morbidity, mortality and hospitalisation, as well as substantial costs to individuals, caregivers and society. Many patients require hospitalisation for treatment of seizure-related accidents, injuries and underlying conditions. Healthcare service utilisation, particularly hospitalisation, is far higher in those with first seizures compared to patients with chronic illnesses. Studies demonstrate the benefits of early epileptologist input regarding diagnostic accuracy, adherence to follow up appointments and delay in seizure recurrence. Unfortunately, as our pilot study regarding first seizure presentations at a large metropolitan centre demonstrated, first seizure management often deviates substantially from recommended practice. In this study we will use state-of-the art data linkage to determine first seizure patient health outcomes including recurrent seizure presentations, all-cause hospital attendances and admissions, serious injuries, comorbidities and mortality. Furthermore, we will determine the health and economic benefits of first seizure clinics as a healthcare intervention through reducing potentially avoidable future health service utilisation by reducing seizure recurrence, morbidity and mortality. Lastly, we will develop a multimodality tool using ‘real-world’ data, including patient and clinical variables and magnetic resonance imaging studies, to predict the chance of seizure recurrence, medical and psychiatric comorbidities, and death, following presentation with a first seizure. This project will establish a solid evidence base for implementation of first seizure clinics into routine practice as an impactful preventative health service intervention, delivering evidence-based care in a cost effective and timely manner. In addition, a robust prognostic model will help identify those at lower risk of seizure recurrence, who may be spared unnecessary workup and costs, as well as those at high risk of seizure recurrence, who may benefit from more intensive monitoring and additional health interventions.