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Gelastic Seizures – HH — SCE Neurology MCQ

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HardEpilepsy & Seizure DisordersGelastic Seizures – HHSCE Neurology

A man with MND and frontotemporal cognitive impairment has troublesome thin drooling despite positioning, swallowing advice and suction strategies. Thick secretions are not present. Which first pharmacological choice best follows NICE?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — A glycopyrronium trial to minimise central anticholinergic adverse effects

Explanation lettering: E = shown as C · C = shown as E

B is correct. NICE recommends an antimuscarinic trial for MND sialorrhoea and specifically favours glycopyrronium when cognitive impairment is present because it crosses the blood–brain barrier less. A and humidification are approaches to thick tenacious saliva, not thin drooling. C may be considered later in selected refractory cases. D reverses the CNS-risk logic. E is too categorical: cognition changes drug selection, not whether symptoms may be treated.

Reference: NICE NG42 — motor neurone disease recommendations: https://www.nice.org.uk/guidance/ng42/chapter/Recommendations