Starting antiepileptic drugs

A 44-year-old male experienced a single, unprovoked, generalized tonic-clonic seizure at 5:30 a.m. The seizure duration was approximately 2 min with gradual recovery following a postictal state. There was no prior history of seizures or predisposing neurological conditions or comorbidity. The only risk factor for epilepsy included a concussion as a child while playing sports. Additionally, the patient did have a sibling with childhood absence epilepsy. The patient was not on prescription medication at the time of the seizure. There was no history of alcohol abuse or illicit drug use. At the time, he was employed, operated a motor vehicle, and was married with two children. Upon evaluation in the emergency department, a CT of the head was normal. An EEG performed several hours after the seizure showed bitemporal independent sharp waves (Fig. 15.1). Other than complaining of a mild headache, myalgias, and a "sore tongue" the patient appeared to be doing well at the time of dismissal from the emergency department. An MRI head was subsequently performed and was unremarkable.