Does someone at 28 need treatment after 1st seizure?

Question

Hello doctor,

My 28-year-old brother experienced his first seizure last week. The episode lasted about two minutes and was followed by confusion afterward. He has never had anything like this before, and it was very frightening for our family.

The emergency room doctors performed some initial tests and discharged him, but we are unsure about the next steps.

Should someone be started on anti-seizure medication after a single seizure, or is observation sometimes appropriate?
Also, what evaluations are typically recommended to determine the underlying cause after a first seizure?

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and understand your concern.

A first seizure can be very frightening, both for the patient and family members. After a first seizure, the main goal is to determine whether it was provoked by a temporary medical issue or whether it may represent an underlying seizure disorder such as epilepsy.

Doctors usually evaluate for possible provoking factors such as:

Low blood sugar.
Electrolyte imbalances.
Fever or infection.
Alcohol or drug withdrawal.
Head injury.
Metabolic disturbances.

Common investigations after a first seizure may include:

Blood tests, including glucose and electrolyte levels.
Kidney and liver function tests.
MRI brain imaging to look for structural abnormalities.
An electroencephalogram (EEG) to assess for abnormal electrical activity in the brain.

Not everybody needs prolonged anti-convulsant medication following an isolated seizure incident. In case of an isolated seizure event with no underlying problems, medication will not necessarily be prescribed right away. Treatment will most probably be recommended if:

MRI (magnetic resonance imaging) or EEG (electroencephalogram) findings are abnormal.
There is a high risk of recurrence.
Another seizure occurs.

Until he is fully evaluated by a neurologist, it is important to take precautions such as avoiding driving, swimming alone, operating heavy machinery, or working at heights. Good sleep, stress reduction, and avoiding alcohol are also important.

A follow-up consultation with a neurologist is recommended for a complete evaluation and discussion of recurrence risk and treatment options.

I hope this helps.

Thank you.