Epilepsy and epileptic seizures have a long history of stigmatization. In the 20th century, epilepsy patients were treated as usual as patients with mental disorders and neurodegenerative diseases. More than 30 years ago, scholars still believed that most patients with a first unprovoked seizure would have more seizures unless they were treated. It was not taken place until Hauser's research reported that landmark changed. However, there is still controversy about workup and treatment for a first unprovoked seizure. No consensus was reached. This article is to review the changes and challenges in the workup, treatment and management of a first unprovoked seizure in children in the past 30 years in order to provide available data and standardized management process.