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Dissociative Seizures — MRCPsych Paper B MCQ

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ModerateAnxiety & Stress-Related DisordersDissociative SeizuresMRCPsych Paper B

A 32-year-old man has recurrent episodes lasting several minutes, often after reminders of a previous assault. During an episode he is motionless with his eyes closed, resists passive eye opening and shows fluctuating responsiveness. Afterwards, he describes having relived the assault and returns rapidly to his usual state. One of his habitual episodes is captured on simultaneous video-EEG, with no epileptic ictal discharge and a preserved normal EEG background throughout. Which condition is most likely?

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Correct answer: A — Dissociative seizure

The best answer is **B, dissociative seizure**. The habitual event has positive functional/dissociative features: prolonged fluctuating unresponsiveness, closed eyes with resistance to opening, trauma-related experiential content and rapid recovery. Most decisively, the typical attack was captured on video-EEG without an epileptic ictal discharge and with a preserved normal background. Generalised tonic-clonic seizures involve tonic and clonic motor activity followed by recovery. Typical absences are usually brief, abrupt episodes lasting seconds. Focal impaired-awareness seizures may include experiential symptoms, but are generally stereotyped and may have automatisms or postictal confusion; a normal routine EEG alone would not exclude them. Catatonic stupor is a sustained psychomotor syndrome rather than a recurrent, brief seizure-like event.

Reference: Whitehead K, Kane N, Wardrope A, Kandler R, Reuber M. Proposal for best practice in the use of video-EEG when psychogenic non-epileptic seizures are a possible diagnosis. Clinical Neurophysiology Practice. 2017;2:130–139. https://pubmed.ncbi.nlm.nih.gov/30214985/