NeurologyGENERAL
First unprovoked seizure in adults — when to start AED and which drug to choose?
35M with no prior seizure history presents with a witnessed generalized tonic-clonic seizure lasting 2 minutes at work. Post-ictal confusion for 20 minutes. No family history of epilepsy. Brain MRI (1.5T) is normal. EEG done 48 hours later is normal. No prior head trauma, meningitis, or substance abuse. ANA, glucose, electrolytes all normal. Per ILAE 2017 guidelines, does a single unprovoked seizure with normal MRI and EEG warrant starting AED? What is the 2-year recurrence risk? If AED is needed, which is preferred in a young male?