The MKSAP Challenge
Answer: B
Educational objective: Manage a patient with a single seizure.
Most neurologists would not start antiepileptic drug therapy after a single seizure unless the patient has one or more risk factors associated with seizure recurrence: abnormal neurologic examination, abnormal electroencephalography or MRI of the brain, partial onset, a history of neurologic injury (such as stroke, hemorrhage or tumor), family history of seizures, or postictal motor paralysis.
This patient has no risk factor for recurrence of seizures. Her seizure was provoked by sleep deprivation. Seizures caused by external events (drug toxicity, drug withdrawal, sleep deprivation, hypoglycemia, hypoxia, hyponatremia) are considered provoked and do not require chronic antiepileptic drug treatment.
Patients with a single provoked seizure should have electroencephalography and MRI to rule out underlying focal pathology that could lower the seizure threshold and precipitate a seizure. Not ordering any tests and just treating the patient with an antiepileptic drug can lead to missing an early diagnosis of brain tumor, small stroke, hemorrhage or other focal cortical abnormality. Reference: Prego-Lopez M, Devinsky O. Evaluation of a first seizure. Is it epilepsy? Postgrad Med. 2002;111:34-6, 43-8. PMID: 11810750.
More information about MKSAP 13 is online.
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