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SUDEP risk counselling — SCE Neurology MCQ

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ModerateEpilepsySUDEP risk counsellingSCE Neurology

A 27-year-old man presented with nocturnal generalised tonic-clonic seizures despite taking levetiracetam irregularly. On examination, neurological examination was normal and there was no structural lesion on prior MRI. Initial investigations showed: seizure diary showed three nocturnal convulsive seizures in two months. What is the most appropriate management?

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Correct answer: B — Start or optimise antiseizure therapy after specialist assessment

Start or optimise antiseizure therapy after specialist assessment is the best answer because the vignette describes SUDEP risk counselling: generalised tonic-clonic seizure frequency and poor adherence are key modifiable SUDEP risks. High-dose intravenous methylprednisolone after excluding infection is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. Optimise dopaminergic therapy and review motor fluctuations and Multidisciplinary rehabilitation with goal-setting are less appropriate because they would require different localisation, timing or test findings; Anticoagulation after excluding contraindications would fit a different syndrome. Clinical pearl: absence seizures alone carry a much lower SUDEP risk.

Reference: NICE NG217; BNF; DVLA Assessing fitness to drive