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First unprovoked seizure — MCCQE Part 1 MCQ

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ModerateSeizuresFirst unprovoked seizureMCCQE Part 1

A 44-year-old man has recovered fully after a first unprovoked generalized tonic-clonic seizure. Glucose, electrolytes and non-contrast CT are normal, and there is no fever, persistent confusion or focal deficit. Which outpatient investigations are most appropriate to refine diagnosis and recurrence risk?

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Correct answer: A — Epilepsy-protocol brain MRI and EEG

After first unprovoked seizure: MRI (more sensitive than CT for structural lesions) and EEG. AED not universally required after single seizure. Canadian driving restrictions: provincially regulated, typically 3-12 months seizure-free.

Reference: https://driversguide.ca/sections/nervous-system/; https://www.cmaj.ca/content/178/7/887