New-Onset Seizures: 7 Critical Questions for Your Doctor

A first seizure is a **neurologic emergency** until proven otherwise. Prepare for your appointment with these questions.

Essential Questions

1. “What type of seizure did I have?” (Focal vs. generalized; motor vs. non-motor) — guides workup and drug choice.
2. “What caused it?” Stroke, tumor, infection, metabolic (Na⁺, glucose), toxic, genetic, autoimmune, unknown (cryptogenic).
3. “Do I need imaging?” MRI brain with/without contrast (gold standard). CT if MRI contraindicated/urgent.
4. “Do I need EEG?” Routine + sleep-deprived. Captures interictal epileptiform discharges; guides classification.
5. “Should I start medication?” After 1st unprovoked seizure: ~40–50% recurrence risk. Factors favoring treatment: abnormal MRI/EEG, nocturnal, Todd’s paralysis, high-risk occupation.
6. “Which medication and why?” Tailored to seizure type, age, sex, comorbidities, drug interactions, pregnancy plans. Monotherapy first.
7. “What safety restrictions apply?” Driving (state laws: 3–12 mo seizure-free), swimming alone, heights, machinery, bathing.

Bring to Appointment

• Witness description (video if possible).
• Medication/supplement list.
• Alcohol/recreational use history.
• Sleep log (last 2 weeks).
• Family seizure history.

Lifestyle Modifications

• Sleep hygiene (regular schedule, 7–9 hrs).
• Limit alcohol (lowers threshold).
• Medication adherence (missed doses = breakthrough).
• Medical alert ID.

Seizure ≠ epilepsy (recurrent unprovoked). But first seizure demands thorough evaluation. Be an active partner.