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First Unprovoked Seizure — RACP Paediatrics MCQ

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ModerateNeurology & DevelopmentFirst Unprovoked SeizureRACP Paediatrics

A 2-year-old is referred after a first unprovoked afebrile seizure. The seizure was a generalised tonic-clonic seizure lasting 3 minutes. He has recovered fully with a normal neurological examination. What is the most appropriate management?

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Correct answer: D — Arrange EEG and MRI brain; anti-seizure medication is NOT routinely recommended after a first unprovoked seizure

After a first unprovoked afebrile seizure with normal neurological exam, EEG and MRI should be performed to assess recurrence risk and identify an underlying cause. Anti-seizure medication is not routinely started after a single unprovoked seizure as the risk of recurrence is approximately 40%. Medication is typically commenced after a second unprovoked seizure.

Reference: RCH Melbourne – 2024 – Clinical Practice Guidelines: First Seizure