Recurrent Seizures and Drowsiness

🗒️ Question

A 22 year old woman is brought to the Emergency Department after experiencing a witnessed generalised tonic-clonic seizure lasting around five minutes. The paramedics report that she remained unconscious post-seizure and had a further seizure en route to the hospital. She has no significant past medical history and takes no regular medications. Her family mentions that she had a similar episode three weeks ago but did not seek medical attention.

On examination, she is drowsy but rousable with a GCS of 13 (E3, V4, M6). Her observations are stable.

Investigations:

• Blood glucose: 5.8 mmol/L (3.9–5.8)

• Serum sodium: 138 mmol/L (135–145)

• Serum potassium: 4.2 mmol/L (3.5–5.1)

What is the most appropriate initial management?

(A) Administer intravenous lorazepam

(B) Start oral phenytoin

(C) Arrange an urgent MRI brain

(D) Refer for electroencephalography

(E) Start oral sodium valproate