First seizure and seizure mimics — formative SAQs

SAQ 1 — Eight-year-old who collapses and jerks in a hot hall (10 marks, 15 minutes)

An eight-year-old boy is brought to the emergency department after collapsing during a long school assembly in a hot hall. A teacher describes that he first went pale and complained of feeling sick and dizzy, then slumped to the ground; his arms and legs jerked a few times for several seconds, and he was back to talking normally within a minute. He is now alert and examination is normal. His teacher wonders if this was a seizure and whether he needs an electroencephalogram and an antiseizure drug. [9]

a) What is the most likely diagnosis, and which three features of the history distinguish this event from a generalised tonic-clonic seizure? (3 marks) [9]

b) Given the setting of the collapse, what specific investigation must you perform before any other test, and which two features in the history or family history would make that investigation mandatory rather than discretionary? (3 marks) [9]

c) Outline your management plan, addressing whether an antiseizure drug is indicated and what first-aid and safety advice you would give the family. Justify your decision not to treat. (4 marks) [9] [4]