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Epilepsy

Seizure Workup

First seizure and new-onset seizure — labs, imaging, EEG

First seizure: rule out provokeers (metabolic, toxin, infection, mass). If unprovoked, work up for epilepsy and decide on driving and treatment.

1.Acute: Rule Out Provoked

Labs: glucose, lytes, renal, LFTs, AED levels, tox, EtOH. LP if febrile or immunocompromised. CT if focal deficit, AMS, or trauma.[+]

2.Imaging

CT acute. MRI brain for etiology (T2/FLAIR, DWI, SWI). Mesial temporal sclerosis, focal dysplasia, cavernoma, tumor.[+]

3.EEG

Routine EEG: epileptiform discharges, focal slowing. Normal EEG common in epilepsy. Sleep-deprived or prolonged if needed.[+]

4.After First Unprovoked Seizure

Recurrence ~40% at 2 y. Higher if abnormal EEG, lesion, or nocturnal. Driving — counsel. AED after first vs after second: shared decision (risk, job, laws).[+]

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