The S2k guideline from the German Society of Neurology in collaboration with the German Society for Epileptology provides comprehensive recommendations for the management of first seizures and epilepsy in adults. It covers five main areas: management of first seizures, pharmacotherapy, epilepsy surgery, complementary and supportive therapies, and psychosocial aspects. The guideline emphasizes the importance of distinguishing between syncope and psychogenic non-epileptic seizures, and highlights the role of EEG, MRI, and lumbar puncture in diagnosis. It also addresses the use of antiseizure medications, particularly for focal, genetic generalized, and unclassified epilepsy, and recommends monotherapy for first seizures. The guideline emphasizes the need for a balanced approach to treatment, considering both seizure control and minimizing adverse effects. It also provides guidance on the management of comorbid conditions such as psychiatric disorders and cognitive impairments. The guideline underscores the importance of psychosocial support, including driving fitness, education, and employment, and highlights the risks associated with seizures, such as SUDEP. It also provides specific recommendations for women of childbearing age, older adults, and individuals with intellectual disabilities, emphasizing the need for tailored treatment approaches. The guideline is a key resource for healthcare professionals in the management of epilepsy in adults.The S2k guideline from the German Society of Neurology in collaboration with the German Society for Epileptology provides comprehensive recommendations for the management of first seizures and epilepsy in adults. It covers five main areas: management of first seizures, pharmacotherapy, epilepsy surgery, complementary and supportive therapies, and psychosocial aspects. The guideline emphasizes the importance of distinguishing between syncope and psychogenic non-epileptic seizures, and highlights the role of EEG, MRI, and lumbar puncture in diagnosis. It also addresses the use of antiseizure medications, particularly for focal, genetic generalized, and unclassified epilepsy, and recommends monotherapy for first seizures. The guideline emphasizes the need for a balanced approach to treatment, considering both seizure control and minimizing adverse effects. It also provides guidance on the management of comorbid conditions such as psychiatric disorders and cognitive impairments. The guideline underscores the importance of psychosocial support, including driving fitness, education, and employment, and highlights the risks associated with seizures, such as SUDEP. It also provides specific recommendations for women of childbearing age, older adults, and individuals with intellectual disabilities, emphasizing the need for tailored treatment approaches. The guideline is a key resource for healthcare professionals in the management of epilepsy in adults.