Non-epileptic events and functional seizures — branching viva

Stem 1 — Thirteen-year-old with bizarre brief nocturnal attacks (5 minutes)

A thirteen-year-old boy is referred for nocturnal attacks in which he suddenly sits up, thrashes his limbs for thirty to sixty seconds with his eyes open, and then returns to sleep. The events cluster, occurring several times a night, and began after he started a new school. His interictal electroencephalogram is normal. ^[1]

Branch A (examiner): What are the two leading diagnoses, and which semiological features would you use to separate a functional event from frontal-lobe epilepsy? ^[1]

Branch B (examiner): The examiner points out that frontal-lobe epilepsy can show a normal scalp electroencephalogram. How do you resolve this, and what further investigation would you arrange? ^[8]

Branch C (examiner): The attacks are captured on video-electroencephalogram and the ictal recording is normal. Explain how you would deliver the diagnosis and outline the management. ^{[3] [10]}