Seizures and Epilepsy

A 32-year-old man with newly diagnosed focal seizures (arising from the left temporal lobe on EEG) presents to the emergency department with a second unprovoked seizure in 2 weeks. He has no prior seizure history, normal MRI brain, and normal metabolic panel. He is alert and oriented post-ictally. What is the most appropriate next step in management?

Which clinical feature best distinguishes generalized tonic-clonic seizures from focal seizures with secondary generalization?

A 28-year-old woman with a 5-year history of seizures presents with a breakthrough seizure despite compliance with levetiracetam. EEG shows focal spike-wave discharges over the left temporal lobe. MRI reveals a 2 cm T2-hyperintense lesion in the left mesial temporal region. Which finding best distinguishes drug-resistant focal epilepsy from drug-responsive focal epilepsy in this patient?

A 28-year-old woman from rural Maharashtra presents to the emergency department with a 2-hour history of continuous seizure activity. She has had 6 generalized tonic-clonic seizures in the past 4 hours without regaining consciousness between episodes. Vital signs: BP 140/90 mmHg, HR 110/min, RR 28/min, temperature 38.2°C. She is on no regular medications and denies prior seizures. After securing the airway and administering oxygen, which of the following is the most appropriate immediate pharmacological intervention?

A 35-year-old man from Delhi presents with a 6-month history of recurrent seizures occurring 2–3 times per week. Seizures are characterized by sudden loss of consciousness, rhythmic jerking of all four limbs lasting 60–90 seconds, followed by post-ictal confusion for 10–15 minutes. There is no aura or focal onset. He has no prior history of head injury, meningitis, or stroke. Neurological examination between seizures is normal. MRI brain is normal. EEG shows 3 Hz spike-and-wave discharges. What is the most likely diagnosis?