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Functional limb weakness — SCE Neurology MCQ

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HardFunctional Neurological DisordersFunctional limb weaknessSCE Neurology

A patient has recurrent prolonged convulsive-appearing attacks despite three antiseizure medicines. The diagnosis remains uncertain. During inpatient recording, a typical unresponsive shaking episode occurs without an ictal EEG pattern; semiology and pre-event EEG are adequately captured and epilepsy specialists confirm the recording is technically interpretable. What is the best conclusion?

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Correct answer: C — Positive explanation of the captured event as a functional seizure

The best answer is “Positive explanation of the captured event as a functional seizure”. A well-recorded habitual event with compatible semiology and no ictal EEG correlate is the diagnostic reference for functional seizures; communication should validate symptoms, explain the mechanism and enable treatment and medication review. “Escalated antiseizure therapy for presumed scalp-negative epilepsy” is less appropriate because convulsive appearance alone does not establish epilepsy “A malingering diagnosis based on absent ictal EEG activity” is less appropriate because functional seizures are involuntary and are not evidence of deliberate deception “Repeat video-EEG because the captured habitual event is discounted” is less appropriate because limitations of scalp EEG require expert interpretation but do not nullify a technically adequate typical-event recording “Continued antiseizure polytherapy pending further clinical reassessment” is less appropriate because unnecessary polytherapy creates adverse effects and reinforces an incorrect disease model

Reference: Psychogenic nonepileptic seizures: EEG and investigation. https://pn.bmj.com/content/16/1/7