A 32-year-old man presents to the Emergency Department following a first episode of a generalized tonic-clonic seizure.

1. What is the neuroimaging investigation of choice for patients presenting to the Emergency Department with a first fit?

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Deferred early outpatient neuroimaging may be used when reliable follow-up is available. Otherwise, neuroimaging in the ED should be performed on all patients.

MRI is preferable to CT, if readily available within an acceptable time period, in a patient who has fully recovered. CT should be used if MRI is not readily available or in an individual who has not fully recovered. In acutely ill patients, CT is the modality of choice.

2. According to the DVLA guidance, how long should a patient have off driving following an isolated seizure?
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According to the DVLA guidance, a patient that has suffered an isolated seizure or first unprovoked seizure must have 6 months off driving from the date of the seizure. 

3. He is subsequently seen by a neurologist and is told his investigations show a high risk of a further seizure (> 20% per annum). How long should he be advised to have off driving?

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If there are clinical factors or investigation results which suggest an unacceptably high risk of a further seizure, i.e. > 20% per annum, then this is increased to 12 months off driving from the date of the seizure.


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