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Functional seizure management — SCE Neurology MCQ

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HardFunctional, Rehabilitation and DVLAFunctional seizure managementSCE Neurology

A 55-year-old has recurrent convulsive-appearing attacks. A typical event is captured on video-EEG with no ictal EEG correlate; MRI is normal. He also has anxiety and adverse effects from antiseizure medication. What is the most likely diagnosis?

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Correct answer: A — Functional (dissociative) seizures

Capture of a typical event without an ictal EEG correlate is strong evidence for functional (dissociative) seizures when interpreted in the clinical context. The diagnosis should be explained positively, unnecessary antiseizure medication reviewed safely, and evidence-based psychological/rehabilitative care offered. This is not a “management” diagnosis or a default conclusion from normal MRI alone.

Reference: Functional neurological disorder: a practical review. https://pmc.ncbi.nlm.nih.gov/articles/PMC7850207/