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Dissociative Seizures – ED Management Plan — SCE Neurology MCQ

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ModerateNeuropsychiatryDissociative Seizures – ED Management PlanSCE Neurology

A 35-year-old woman with a diagnosis of functional neurological disorder (dissociative seizures confirmed by video-EEG) continues to attend the emergency department frequently with prolonged events. She is often given IV lorazepam by the admitting team, which does not stop her events but causes respiratory depression. What should the emergency department team be advised?

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Correct answer: A — Communicate the confirmed diagnosis to the ED team; create an individualised management plan that avoids benzodiazepines for non-epileptic events and includes de-escalation strategies

Patients with confirmed dissociative (non-epileptic) seizures should have an individualised emergency care plan that is shared with the ED team, GP, and ambulance service. This plan should clearly state the diagnosis, advise against benzodiazepine administration (which is ineffective and risks respiratory depression), and outline appropriate management (calm environment, verbal reassurance, safety positioning, de-escalation). Repeated inappropriate benzodiazepine use is a significant iatrogenic harm risk. A: The diagnosis is confirmed — benzodiazepines are not indicated. C: Phenytoin is not indicated. D: Intubation is not needed for non-epileptic events. E: Assessment is still needed to exclude concurrent medical problems.

Reference: NICE NG217 (2025); ABN Dissociative Seizures Guidelines; CODES Trial