 A 60-year-old woman is admitted to the hospital after a loss of consciousness. She had a “strange feeling” before losing consciousness with convulsions. Her husband stated that she fell to the ground and had generalized stiffening and then shaking. She was unresponsive for approximately 3-5 minutes, had urinary incontinence, and was confused for a few minutes after regaining consciousness. She had a similar episode 2 months ago after she was struck in the head; evaluation at that time, which included electrocardiography, stress electrocardiography, and a continuous-loop event electrocardiographic recorder, revealed no abnormal findings. The patient takes no prescriptive medications, OTC, or herbals. Physical examination including a full neurologic examination is normal. MRI of the brain and electroencephalogram (EEG) during waking and sleeping are also normal. All other pertinent labs are within normal limits.
a. What is the most likely diagnosis and why?
b. What would you order for this patient initially and why?
c. You determine that the patient needs chronic medication; what would you order for long term control and what are the major patient counseling points?