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Functional Seizures — SCE Neurology MCQ

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HardNeuropsychiatryFunctional SeizuresSCE Neurology

During prolonged shaking episodes, a patient remains responsive, keeps the eyes tightly closed and has no ictal EEG change during a typical event. What is the most accurate diagnosis?

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Correct answer: B — Functional (dissociative) seizures confirmed by video-EEG, in this clinical phenotype, clinically

The best answer is “Functional (dissociative) seizures confirmed by video-EEG, in this clinical phenotype, clinically”. A typical recorded episode without ictal activity plus positive semiology supports functional seizures; the diagnosis should be communicated as real and treatable. “Frontal-lobe epilepsy excluded solely because movements are complex” remains a plausible alternative in a different presentation, but it does not fit the decisive finding or management threshold here. “Generalised convulsive status epilepticus despite retained interaction” remains a plausible alternative in a different presentation, but it does not fit the decisive finding or management threshold here. “Syncope with cerebral hypoperfusion lasting fifteen minutes” remains a plausible alternative in a different presentation, but it does not fit the decisive finding or management threshold here. “Paroxysmal dyskinesia caused by a basal-ganglia lesion” remains a plausible alternative in a different presentation, but it does not fit the decisive finding or management threshold here.

Reference: JNNP practical review of functional neurological disorder: https://jnnp.bmj.com/content/92/1/53