MRCP2-3138

MRCP2-3138

A 35-year-old woman presents to the Emergency Department with a first episode of generalised tonic-clonic seizure. She is accompanied by her husband, who says she collapsed after coming home from work and suffered 3 minutes of generalised limb jerking, some foaming at the mouth and incontinence of urine.
Further collateral history revealed that she had been vacant on a number of occasions for a few minutes. This also involved lip-smacking. She describes a feeling of déjà vu and a feeling of anxiety in her abdomen and chest area immediately prior to these episodes. On a number of these occasions, she seemed to lose track of where she was for some minutes.
Past medical history includes migraines. There is no family history of note. Neurological examination in the clinic is unremarkable.
Investigations:

Haemoglobin 145 g/l 135–175 g/l
White cell count (WCC) 7.2 × 109/l 4–11 × 109/l
Platelets 190 × 109/l 150–400 × 109/l
Sodium (Na+) 142 mmol/l 135–145 mmol/l
Potassium (K+) 4.5 mmol/l 3.5–5.0 mmol/l
Creatinine 90 µmol/l 50–120 µmol/l
CT Head Normal
What is the most likely diagnosis?