A 31-year-old has a first unprovoked nocturnal generalised tonic-clonic seizure with tongue biting and postictal sleepiness. He has returned to

Question

A 31-year-old has a first unprovoked nocturnal generalised tonic-clonic seizure with tongue biting and postictal sleepiness. He has returned to baseline, ECG and blood tests are normal, and there is no fever or focal neurological deficit. What is the most appropriate immediate plan?

Accepted Answer

Provide seizure-safety and driving advice and arrange urgent first-seizure specialist assessment

Answer

Start long-term antiseizure medication immediately because any nocturnal convulsion confirms epilepsy

Answer

Arrange repeat CT only after a second seizure and withhold driving advice until then

Answer

Discharge without neurological follow-up because normal examination and ECG exclude recurrence risk

Answer

Arrange lumbar puncture before referral because all first seizures require cerebrospinal-fluid analysis

First unprovoked seizure — SCE Neurology MCQ

A 31-year-old has a first unprovoked nocturnal generalised tonic-clonic seizure with tongue biting and postictal sleepiness. He has returned to baseline, ECG and blood tests are normal, and there is no fever or focal neurological deficit. What is the most appropriate immediate plan?