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Provoked Seizure – Substance-Related — SCE Neurology MCQ

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EasyEpilepsy & Seizure DisordersProvoked Seizure – Substance-RelatedSCE Neurology

A 22-year-old man has a single witnessed generalised tonic-clonic seizure at a music festival. He reports consuming a large amount of alcohol and MDMA (ecstasy) over the preceding 12 hours. He has no previous seizure history. CT head and routine bloods (including glucose, sodium, calcium) are normal. Temperature is 37.8°C. What is the most appropriate approach?

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Correct answer: D — Manage as a provoked seizure; no antiseizure medication required but advise on substance avoidance and safety netting

A seizure occurring in the context of acute alcohol and recreational drug use (MDMA lowers seizure threshold and may cause hyponatraemia, hyperthermia) is a provoked (acute symptomatic) seizure. It does not constitute epilepsy and does not require long-term antiseizure medication. Management includes treating any acute complications (hyperthermia, hyponatraemia, dehydration), substance misuse advice, and safety netting with advice to seek medical attention if further seizures occur. A: Long-term medication is not indicated for provoked seizures. B: A single provoked seizure does not meet criteria for epilepsy. D: LP is not indicated with normal CT and clear provoking factors. E: Video-EEG is not needed.

Reference: NICE NG217 (2025); ILAE Definitions – Acute Symptomatic Seizures