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Background/Objectives To explore changes in quality of life, mood, and work productivity from initial clinical contact to 12 months later for people with first seizure events.Methods Prospective longitudinal multicentre study. Adults were recruited from five Australian and US Epilepsy Centres. Inclusion criteria for the study group were new diagnoses of acute symptomatic seizures, unprovoked seizures, and epilepsy, and for the comparator groups were diagnoses of non-cardiac syncope and functional seizures. Participants completed patient reported outcome measures at baseline (initial clinic appointment), 6- and 12 months later.Results Among the 265 participants enrolled, 101 (38.1%) had newly-diagnosed epilepsy, 60 (22.6%) unprovoked seizures, 46 (17.4%) acute symptomatic seizures, 49 (18.5%) syncope, and 9 (3.4%) functional seizures. Median age was 42 years (IQR 28–58) and 56.6% (n=150) were males. At baseline, the functional seizure group had younger participants with lower QOLIE-31 total scores and higher anxiety and depressive symptomatology compared to all other diagnostic groups. Twelve-month follow-up data were available for acute symptomatic seizure, newly-diagnosed epilepsy, and syncope groups. Acute symptomatic seizure and newly-diagnosed epilepsy groups had improvement in QOLIE-31 scores and reduced informal care needs between baseline and 12-month timepoints, but the syncope group did not. There was no change in anxiety or depressive symptomatology or change in employment for these three groups over time.Conclusion Quality of life improved for people with acute symptomatic seizures and newly-diagnosed epilepsy over time, but anxiety and depressive symptomatology did not. Future studies may explore interventions to support mood following first seizure events.