QuestionSBA
QuestionChoice
The most likely diagnosis is non-epileptic attack disorder. A ketogenic diet may be advised in certain forms of epilepsy, after initiation of anti-epileptic drugs.
10028438
c
Advise a ketogenic diet
QuestionChoice
The most likely diagnosis is non-epileptic seizure disorder, which is not treated with anti-epileptic drugs. Valproate may be initiated if further evidence of epilepsy comes to light, but would likely be avoided in a woman of childbearing age.
10028439
d
Initiate on valproate
QuestionChoice
This is correct. This description is typical for non-epileptic seizures whereby patients remain alert, the onset is gradual, and an emotional response may follow. The non-epileptiform EEG supports this diagnosis. Non-epileptic seizures may be related to underlying anxiety or stresses and psychotherapy is the preferred treatment.
10028436
a
Refer for psychotherapy
QuestionChoice
The most likely diagnosis is non-epileptic seizure disorder, which is not treated with anti-epileptic drugs. Lamotrigine may be initiated if further evidence of epilepsy comes to light, as it is preferred to valproate (as it is less teratogenic) in a woman of childbearing age.
10028440
e
Initiate on lamotrigine
QuestionChoice
This is not appropriate given CBT and psychotherapies are the preferred treatment for non-epileptic attack disorder. It is important to note that these episodes can have a significant impact on patients' lives.
10028437
b
Reassurance with no further action
QuestionComment
I dont think theres enough to confirm non epileptic. neurologist told me normal EEG can still be epilepsy
62281
User
subscriber
Henza
Concept
Chapter
2693
6062
Seizures and Blackouts
Topic
141
Neurology
18085
Non-epileptic seizures are characterised by preserved awareness and emotional responses, often requiring psychotherapy rather than pharmacological treatment.
A 35 year old woman is referred to a 'first fit' clinic by her GP.

She describes multiple episodes of gradual onset limb shaking and jerking, during which she is responsive and after which she cries. Her mother has epilepsy.

An EEG is performed which does not show any epileptiform activity.

What is the most appropriate course of action?
a