First suspected seizure — assessment, safety and driving advice

PLAB 2 & PRES 3 · neurology · hard · 8 minutes

Candidate brief

You are an FY2 doctor/SHO in the Emergency Department. Mr James Nolan, 33, was brought in after collapsing at work with witnessed stiffening and jerking movements. He is now fully alert and his initial observations are stable. Assess the episode, explain the likely diagnosis and arrange appropriate investigation, follow-up, safety and driving advice. No physical examination is required, but verbalise any examination or further assessment you would undertake.

What examiners look for

A first suspected seizure requires a detailed description from both the patient and an eyewitness. Video footage may help when it can be obtained safely. Features supporting a tonic-clonic seizure include sudden loss of awareness, stiffening followed by rhythmic jerking, lateral tongue biting, cyanosis and a prolonged period of confusion afterwards. Consider important mimics and causes, including syncope, cardiac arrhythmia, hypoglycaemia, electrolyte disturbance, intoxication or withdrawal, infection, head injury, functional seizures and sleep-related events. Assess ABCDE, glucose, injuries and recovery to neurological baseline. Obtain cardiovascular and complete neurological examinations. A 12-lead ECG is required because cardiac arrhythmias and syncope can resemble an epileptic seizure. Use targeted blood tests according to the presentation. Urgent brain imaging is required when structural disease, injury, infection or continuing neurological abnormality is suspected. It is not automatically required for every fully recovered patient. A normal EEG does not exclude epilepsy. EEG supports classification and diagnosis when interpreted alongside the clinical history. Do not automatically diagnose epilepsy or prescribe long-term antiseizure medication after one recovered seizure. Provide urgent specialist follow-up, written first-aid information, clear emergency criteria and advice to record any further event. The patient must stop driving immediately. Ask about ordinary and commercial licence categories because the restrictions differ. Temporarily avoid ladders, roofs, unguarded heights, dangerous machinery, open flames, bathing alone and unsupervised swimming. Encourage adequate sleep and avoidance of binge alcohol and recreational drugs without implying that sleep deprivation alone proves the seizure was provoked.

Guideline references

Practise this station

Role-play it with an AI patient and get feedback against the full marking scheme. Create a free account — 3 stations per month free.