Epilepsy Risk after First Seizure (MESS Score)
MESS prognostic index (Kim 2006, from the MRC Multicentre trial for Early Epilepsy and Single Seizures). Predicts seizure recurrence after a single seizure or early epilepsy and the benefit of immediate antiepileptic treatment.
Score interpretation
Single seizure, no neurological disorder, normal EEG. Kim 2006: little benefit from immediate treatment in this group.
→ 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)
2–3 seizures, or a neurological disorder, or an abnormal EEG. Kim 2006: potentially worthwhile benefit from immediate treatment.
→ Discuss AED benefits vs risks with the patient; treat if the patient feels the risk is unacceptable. Common choices: levetiracetam, lamotrigine. Valproate must not be started in anyone under 55 unless two specialists agree there is no alternative (MHRA 2024). DVLA guidance.
Two of these features, or ≥ 4 seizures. Kim 2006: potentially worthwhile benefit from immediate treatment.
→ AED initiation recommended; personalise choice by epilepsy type and comorbidities (valproate only within the MHRA 2024 restrictions); 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.