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First Unprovoked Seizure – Recurrence Risk — SCE Neurology MCQ

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HardEpilepsy & Seizure DisordersFirst Unprovoked Seizure – Recurrence RiskSCE Neurology

Several adults develop diplopia, fixed dilated pupils, dysphagia and symmetrical descending flaccid paralysis after sharing home-preserved food. Sensation is intact. What action is time-critical?

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Correct answer: C — Contact UKHSA for antitoxin and provide urgent respiratory support

The best answer is “Contact UKHSA for antitoxin and provide urgent respiratory support”. The clustered cranial-nerve-predominant descending paralysis is foodborne botulism; antitoxin neutralises circulating toxin and should not await laboratory confirmation. “Wait for toxin confirmation before seeking antitoxin” can be reasonable in another presentation, but it does not account for the defining feature here. “Start pyridostigmine as definitive treatment for myasthenia gravis” can be reasonable in another presentation, but it does not account for the defining feature here. “Give intravenous immunoglobulin for presumed Guillain–Barré syndrome” can be reasonable in another presentation, but it does not account for the defining feature here. “Use corticosteroid monotherapy for brainstem encephalitis” can be reasonable in another presentation, but it does not account for the defining feature here.

Reference: UKHSA botulism clinical and public health management: https://www.gov.uk/government/publications/botulism-clinical-and-public-health-management/botulism-clinical-and-public-health-management