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COMT – Levodopa Dose Reduction — SCE Neurology MCQ

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HardMovement DisordersCOMT – Levodopa Dose ReductionSCE Neurology

A 29-year-old continues to have disabling bilateral tonic seizures despite appropriate trials of four antiseizure regimens. Stereo-EEG shows independent multifocal onsets involving eloquent cortex, and a tertiary epilepsy-surgery conference concludes that resection is unsuitable. What procedure should now be discussed?

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Correct answer: A — Vagus-nerve stimulation after counselling that benefit is palliative and variable

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

D is correct. NICE places VNS after drug resistance and tertiary assessment has found resective surgery unsuitable or unsuccessful; benefit and procedural risk must be discussed because response is variable. A lacks a resectable concordant focus. B may be considered for selected drop-attack syndromes but is not mandatory. C is not the routine NICE sequence. E adds delay after definitive tertiary evaluation without changing resectability.

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