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Photosensitive epilepsy — SCE Neurology MCQ

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ModerateEpilepsyPhotosensitive epilepsySCE Neurology

A 79-year-old woman presented with brief myoclonic jerks and one convulsion triggered by club strobe lights. On examination, examination was normal and there was no focal neurological deficit. Initial investigations showed: EEG with intermittent photic stimulation produced generalised polyspike-wave discharges. What is the most appropriate management?

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

Start or optimise antiseizure therapy after specialist assessment is the best answer because the vignette describes Photosensitive epilepsy: photoparoxysmal EEG response with stimulus-triggered seizures indicates photosensitive epilepsy. Intravenous immunoglobulin with respiratory monitoring is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. Empirical intravenous ceftriaxone after blood cultures and Specialist counselling about driving and DVLA notification are less appropriate because they would require different localisation, timing or test findings; Intravenous aciclovir pending diagnostic confirmation would fit a different syndrome. Clinical pearl: focal occipital epilepsy may also be light-sensitive but usually has visual focal symptoms.

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