Epilepsy

LS is a 31-year-old woman who presents after a first-time seizure. The patient recalls experiencing an unusual rising sensation in the abdomen accompanied by an unpleasant, brief, metallic taste before losing awareness. Bystanders observed her to develop leftward head turning followed by stiffening and rhythmic jerking of her limbs. She appeared disoriented for 15 minutes following the event but steadily recovered to baseline functioning. 

Past Medical History 

• Febrile convulsion in childhood following pneumonia at the age of 10 

• No birth-related or developmental complications Medications 

• Fluoxetine, 40 mg once daily Family History 

• Uncle with alcohol-associated withdrawal seizures 

Labs 

• Electrolytes: Normal 

• Blood glucose level: Normal 

• Urine toxicology screening: Negative 

Discussion Questions 

1. What is an important risk factor that might have contributed to LS’s epilepsy?

 2. Initial workup reveals normal electrolytes, normal blood glucose level, and negative urine toxicology screening. Which diagnostic studies should be obtained to further understand the risk of recurrent unprovoked seizures? 

3. An EEG is obtained and shows epileptiform discharges over the right temporal head region. What is the best next course of action in terms of antiseizure therapy?