Alcohol withdrawal seizure — SCE Neurology MCQ

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HardEpilepsyAlcohol withdrawal seizureSCE Neurology

Two generalised seizures occur 48 hours after abrupt cessation of heavy alcohol use, with autonomic overactivity, normal CT and hypomagnesaemia. What is the immediate management priority?

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Correct answer: C — Treat alcohol withdrawal and correct metabolic abnormalities

The best answer is “Treat alcohol withdrawal and correct metabolic abnormalities”. The timing, autonomic activation and typical generalised seizures support alcohol withdrawal. Benzodiazepine-based withdrawal treatment, thiamine and correction of magnesium take priority; routine chronic antiseizure therapy or epilepsy-protocol imaging is not automatically indicated. The alternatives “Start indefinite antiseizure monotherapy immediately”, “Arrange outpatient epilepsy surgery assessment”, “Perform routine lumbar puncture for autoimmune epilepsy”, “Attribute autonomic signs to a primary anxiety disorder” are clinically adjacent possibilities, but they do not match the defining chronology, localisation, physiology, investigation result or UK management sequence in this stem.

Reference: National Clinical Guideline for Stroke: acute care: https://www.strokeguideline.org/chapter/acute-care/