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Focal impaired-awareness seizure from mesial temporal sclerosis — SCE Neurology MCQ

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HardEpilepsyFocal impaired-awareness seizure from mesial temporal sclerosisSCE Neurology

A 61-year-old with motor neurone disease has new orthopnoea and morning headaches. PaCO2 is 5.7 kPa and seated FVC is 72% predicted. There is no infection or secretion problem. What is the most appropriate next step?

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Correct answer: C — Refer for overnight respiratory assessment and discuss non-invasive ventilation

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

A is correct. NICE treats symptoms—particularly orthopnoea—as important even when PaCO2 is no higher than 6 kPa; FVC below 80% plus respiratory symptoms also crosses a listed assessment threshold. B delays evaluation. C can worsen hypoventilation and does not provide ventilatory support. D bypasses the usual non-invasive pathway. E incorrectly requires daytime hypercapnia.

Reference: NICE NG42: Motor neurone disease: https://www.nice.org.uk/guidance/ng42/chapter/Recommendations