Non-epileptic events and functional seizures — formative SAQs

SAQ 1 — Fourteen-year-old with treatment-resistant spells (10 marks, 15 minutes)

A fourteen-year-old girl is referred to the epilepsy service for spells that began a year ago and occur several times a week. Each lasts five to ten minutes: she slumps, her eyes are closed and she resists them being opened, her limbs move in a variable thrashing pattern, she occasionally groans, and within a minute of the event ending she is tearful but fully oriented. She has been started on two escalating antiseizure medications without any change in the events. Her parents separated six months ago, and her mother has a history of depression. ^[2]

a) What is the most likely diagnosis, and which four features of the events support it over epilepsy? Explain why the antiseizure drugs have not worked. (4 marks) ^{[1] [2]}

b) Describe the investigation that confirms the diagnosis, how it is performed, and what it must demonstrate. State why a normal interictal electroencephalogram alone is not sufficient. (3 marks) ^{[1] [8]}

c) Outline the stepwise management, including the conversation you would have with the girl and her family about the nature of the events, the role of the antiseizure drugs, and the pathway to recovery. (3 marks) ^{[3] [10]}