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Video-EEG – Purpose — SCE Neurology MCQ

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HardClinical NeurophysiologyVideo-EEG – PurposeSCE Neurology

A 34-year-old with focal epilepsy continues to have disabling seizures despite tolerated, appropriately chosen trials of levetiracetam and lamotrigine. MRI is normal and interictal EEG is non-localising. What should happen next?

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Correct answer: A — Tertiary surgical assessment with video-EEG despite normal MRI

Explanation lettering: B = shown as A · E = shown as B · A = shown as D · D = shown as E

B is correct. NICE recommends discussing and referring all people with drug-resistant epilepsy for tertiary resective-surgery assessment, including MRI-negative cases. Video telemetry, specialised imaging and neuropsychology can establish concordance. More sequential drug trials, a normal MRI or non-localising interictal EEG should not block referral; VNS is considered when resection is unsuitable or unsuccessful, not before assessment.

Reference: NICE NG217 non-pharmacological epilepsy treatment: https://www.nice.org.uk/guidance/ng217/chapter/non-pharmacological-treatments