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Dissociative Seizures – DVLA — SCE Neurology MCQ

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HardEpilepsy & Seizure DisordersDissociative Seizures – DVLASCE Neurology

A 7-year-old has dozens of daily 8-second episodes of stereotyped mirthless laughter with preserved awareness. Routine scalp EEG during several events shows no ictal change. MRI shows a sessile lesion attached to the tuber cinereum. Which interpretation best integrates the findings?

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Correct answer: D — Hypothalamic-hamartoma gelastic seizures; deep onset can leave scalp ictal EEG negative

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

A is correct. Brief, frequent, stereotyped gelastic seizures—often with retained awareness—are the characteristic initial seizure of hypothalamic hamartoma, and deep onset can leave scalp EEG uninformative. B does not explain the lesion or paroxysmal stereotypy. C requires generalised EEG and impaired awareness. D is a loss-of-tone phenomenon. E produces context-linked, less highly stereotyped emotional expression with structural corticobulbar disease.

Reference: ILAE EpilepsyDiagnosis — hypothalamic hamartoma: https://www.epilepsydiagnosis.org/aetiology/hh-videos.html