Epilepsy Risk after First Seizure (MESS Score)
Multicentre Epilepsy and Single Seizures (MESS) study score. Predicts risk of seizure recurrence after a first unprovoked seizure and guides early AED initiation.
Score interpretation
→ DVLA: do not drive for 6 months (first seizure); no immediate AED; follow-up neurology within 2 weeks; EEG and MRI brain; safety advice (swimming, heights)
→ Discuss AED benefits vs risks with patient; consider if patient feels risk unacceptable; most common: levetiracetam, lamotrigine, sodium valproate (avoid in women of childbearing age); DVLA guidance
→ AED initiation recommended; personalise choice by gender/epilepsy type/comorbidities; VPA (men/post-menopause), levetiracetam/lamotrigine (women); DVLA: 12 months no driving if 2+ seizures; neurology urgently
Interpretation bands for the First Seizure Risk. Apply clinical judgement and local guidance.
References
Related
Curated clinical cross-links plus same-class fallbacks.
- Promethazine hydrochloride · First-generation H1-antihistamine (phenothiazine)
- Tolbutamide · First-generation sulfonylurea (short-acting)
- Chlorphenamine (Chlorpheniramine) · Sedating Antihistamine (H1 Antagonist — First-generation)
- Cyproheptadine hydrochloride · First-generation antihistamine + 5-HT₂A antagonist
- Sodium Valproate (Epilepsy in Elderly) · Antiepileptic
- Cefalexin · First-Generation Cephalosporin — Skin / Soft Tissue / UTI
- Acute Stroke / TIA Assessment · NICE NG128; RCP Stroke Guidelines 2023
- Status Epilepticus (Adults) · NICE CG137; ESEM guidelines; RCP Neurology Guidelines
- Suspected Subarachnoid Haemorrhage · NICE NG228; RCEM 2023; AHA/ASA 2023
- Adult Head Injury · NICE NG232 (2023)
- Bell's Palsy / Facial Nerve Palsy · ENT UK 2017; AAN
- Vertigo Workup · ENT UK; NICE CKS
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.