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Dissociative Seizures – CBT Treatment — SCE Neurology MCQ

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HardNeuropsychiatryDissociative Seizures – CBT TreatmentSCE Neurology

Video-EEG has captured typical dissociative seizures without ictal activity. The patient accepts the diagnosis and wants treatment. What is the best next step?

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Correct answer: D — Give a clear positive explanation, in this clinical phenotype

The best answer is “Give a clear positive explanation, in this clinical phenotype”. Effective care begins with a non-stigmatising explanation and coordinated treatment; antiseizure medicines do not treat functional seizures unless epilepsy coexists. “Escalate long-term antiseizure medication” is a credible alternative elsewhere, but it fails the decisive discriminator in this case. “Use benzodiazepines to terminate every event” is a credible alternative elsewhere, but it fails the decisive discriminator in this case. “Refer directly for epilepsy surgery” is a credible alternative elsewhere, but it fails the decisive discriminator in this case. “Advise that symptoms are voluntary and cannot improve” is a credible alternative elsewhere, but it fails the decisive discriminator in this case.

Reference: NICE NG217 epilepsy recommendations: https://www.nice.org.uk/guidance/ng217/chapter/Recommendations