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First unprovoked seizure — MCCQE Part 1 MCQ

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ModerateSeizuresFirst unprovoked seizureMCCQE Part 1

A 27-year-old man has a witnessed generalized tonic-clonic seizure lasting 90 seconds with postictal confusion. He is now back to baseline, glucose is normal and there is no fever or meningism. Which of the following is the most appropriate next step?

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Correct answer: D — Assess for provoking causes, arrange EEG and neuroimaging, and counsel about driving restrictions

A first unprovoked seizure requires evaluation for provoking causes and structural epilepsy risk, with EEG and neuroimaging depending urgency. Automatic lifelong therapy is not always required after a single seizure, but driving restriction counselling is essential in Canadian practice and varies provincially. Lumbar puncture is reserved for suspected CNS infection or subarachnoid haemorrhage.

Reference: Canadian League Against Epilepsy practice; provincial fitness-to-drive standards