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Post-traumatic epilepsy — SCE Neurology MCQ

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HardEpilepsyPost-traumatic epilepsySCE Neurology

A 48-year-old woman presented with recurrent focal seizures one year after severe traumatic brain injury. On examination, there was anosmia and mild executive dysfunction. Initial investigations showed: MRI showed bilateral inferior frontal and temporal encephalomalacia. What is the most likely diagnosis?

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Correct answer: D — Post-traumatic epilepsy

Post-traumatic epilepsy is the best answer because the vignette describes Post-traumatic epilepsy: remote seizures after severe head injury indicate post-traumatic epilepsy. Juvenile myoclonic epilepsy is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. Focal impaired-awareness seizure from mesial temporal sclerosis and Epilepsia partialis continua are less appropriate because they would require different localisation, timing or test findings; Gelastic seizure from hypothalamic hamartoma would fit a different syndrome. Clinical pearl: acute seizures within a week of injury are provoked and managed differently.

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