7. Management of first-time seizure

Seizures are the bread and butter of the neurological consult service. Gaining proficiency in the workup and management of first-time seizures makes a young neurologist’s life much easier. To shed some light on this topic, I sit down with the incredible Dr. Brian Day, an Epileptologist at Washington University, to discuss the ins and outs of first-time seizure management. Dr. Day got his MD and PhD at the University of Kentucky and completed his neurology training at Washington University. He then did a fellowship in Epilepsy and currently works treating patients with seizure disorders.

Time stamps:

  • 1:00: My experience with epilepsy
  • 5:23: Why neurology
  • 12:13: What did you study for your PhD?
  • 16:43: Why epilepsy?
  • 21:53: What do you like to do in your free time?
  • 25:53: Patient case of new onset seizure
  • 27:57: What is a seizure?
  • 30:16: How can you tell if shaking is a seizure?
  • 37:45: Non-epileptic events
  • 41:41: Provoked vs unprovoked seizures
  • 42:53: Medications that can provoke a seizure
  • 47:38: Can certain longstanding medications cause seizures?
  • 49:25: How to counsel seizure patients about alcohol consumption
  • 51:58: Acute symptomatic vs remote seizures
  • 56:08: Neuroimaging for new onset seizure
  • 58:43: Screening for mesial temporal sclerosis
  • 59:53: What to look for on brain MRI
  • 1:00:53: What to look for on EEG
  • 1:05:53: Lab workup/when to get a lumbar puncture
  • 1:07:46: Can a UTI provoke a seizure?
  • 1:12:08: Focal vs generalized seizures
  • 1:13:44: Neurological exam for seizures
  • 1:16:52: Do multiple seizures in a day change prognosis?
  • 1:19:13: Role of serum lactate/prolactin
  • 1:21:08: When do you start antiepileptics?
  • 1:23:43: What to do with an abnormal EEG
  • 1:25:05: Deep vs cortical brain MRI lesiosn and seizure risk
  • 1:28:08: How to manage unprovoked seizure patients older than 60
  • 1:30:19: Benzo bridges
  • 1:32:43: Follow up for patients
  • 1:33:46: Counseling patients with first time seizures
  • 1:37:43 Summary


Dr. Day report no relevant financial disclosures. Brain Boy Neurology reports no relevant financial disclosures.