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Psychogenic non-epileptic seizure — SCE Neurology MCQ

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ModerateEpilepsyPsychogenic non-epileptic seizureSCE Neurology

A 48-year-old man presented with prolonged shaking episodes with asynchronous limb movements and retained eyelid resistance. On examination, there was rapid recovery and no lateral tongue bite, cyanosis or postictal confusion. Initial investigations showed: video-EEG captured a typical attack without epileptiform correlate. What is the most likely underlying mechanism?

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Correct answer: E — dissociation and abnormal predictive motor control

dissociation and abnormal predictive motor control is the best answer because the vignette describes Psychogenic non-epileptic seizure: captured habitual attacks without EEG correlate support functional seizures. Large-vessel thromboembolism is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. Trigeminal autonomic reflex activation and Granulomatous vessel wall inflammation are less appropriate because they would require different localisation, timing or test findings; Dopamine receptor blockade would fit a different syndrome. Clinical pearl: a normal routine EEG alone would not prove the diagnosis.

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