47 year old male with seizures

[pbruss]

47 yo male with no PMHx, takes no meds, has never seen a doctor. Came in by EMS for witnessed seizure. Wife called EMS because she was awoken by him shaking in bed. postictal when EMS arrives and has a second tonic clonic seizure as he is being transferred off the EMS cot that resolves with ativan and he returns to baseline. states he and his wife went to the bar and had a few drinks. he does not smell like ETOH and does not appear intoxicated. 

HR - 130. BP 160/95. T - 37. O2 - 98% on RA

AAO x 3 in no distress
CV - tachy but RRR no MRG
Lungs - CTA
ABD - WNL
EXT - Skin flushed and warm to touch, no CCE, rashes or edema

attached is his EKG with no old for comparison. based on your interpretation, what etiologies should be considered for the cause of his seizures

Attachments:

[Bjs04f]

Tox, Rsr' in avr with r'>r significant for Na channel blockade seen in cocaine and tca overdose. I would be strongly considering a toxicology etiology

[pbruss]

very well played. also remember R'>R very sensitive an specific for refractory seizures in that setting. i was convinced he would be positive for one of those things but he wasn't. turns out after the bar he went to his buddies house and drank home made moonshine. nephrologist thinks it may have been methanol. however he might of also been in new onset DKA, its not 100% clear. guy did fine, had no more seizures. couldn't find any literature that menthanol acts like sodium channel blocker.