An adult woman has a witnessed generalized seizure with tongue biting and urinary incontinence, followed by a postictal state. The most likely etiology is?

• A. Epilepsy
• B. Hyperventilation
• C. Cardiac arrhythmia
• D. Seizure

Answer: (D)

This pattern points to a generalized tonic-clonic seizure. Tongue biting, particularly on the side of the tongue, and urinary incontinence are classic during the convulsive phase, and a postictal state—confusion and fatigue after the event—follows the seizure. Epilepsy would require a tendency for recurrent unprovoked seizures, so this could be the first seizure rather than epilepsy. Hyperventilation can trigger seizures in susceptible individuals but doesn’t explain the observed sequence, and cardiac arrhythmia typically causes syncope with less characteristic postictal confusion and tongue biting. Taken together, the immediate etiology of this event is a seizure.