Patients without a provoked cause of first seizure require imaging

MRI is the imaging modality of choice: it can depict subtle abnormalities that may go unrecognised on CT. Specific MR seizure protocols may be utilised in order to identify the epileptogenic focus.

In the emergency setting, contrast enhanced CT of the brain is a useful initial investigation, with follow-up MRI

Parieto-occipital A-V malformation

MRI showing cavernoma, front right epilepsy (TOP) left temporal lobe epilepsy due to cavernoma (BOT)