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Dissociative seizures — SCE Neurology MCQ

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HardEpilepsyDissociative seizuresSCE Neurology

A patient reports brief stereotyped nocturnal hypermotor attacks. Routine EEG is normal, but events arise abruptly from sleep, last 30 seconds and occur several times nightly without prolonged unresponsiveness. What is the best diagnostic next step?

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Correct answer: C — Arrange prolonged video-EEG assessment to distinguish sleep-related hypermotor epilepsy from parasomnia or functional events

The best answer is “Arrange prolonged video-EEG assessment to distinguish sleep-related hypermotor epilepsy from parasomnia or functional events”. A normal routine EEG does not exclude frontal seizures; capturing a typical event with video-EEG and sleep correlation is the decisive investigation. “Diagnose dissociative seizures solely because routine EEG is normal” is plausible in a different neurological context, but the decisive findings here argue against it. “Start indefinite benzodiazepines without capturing an event” is plausible in a different neurological context, but the decisive findings here argue against it. “Exclude epilepsy because vigorous movements cannot be epileptic” is plausible in a different neurological context, but the decisive findings here argue against it. “Request dopamine-transporter imaging” is plausible in a different neurological context, but the decisive findings here argue against it.

Reference: NICE NG217 epilepsy recommendations: https://www.nice.org.uk/guidance/ng217/chapter/Recommendations