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]

SAQ 2 — Fifteen-year-old with treatment-resistant events (10 marks, 15 minutes)

A fifteen-year-old girl is referred for events 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 on two escalating antiseizure medications without change in the events. She recently moved schools after family breakdown, and her mother has a history of depression. [10]

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) [10] [9]

b) Describe the investigation that confirms the diagnosis, and outline how it is performed and what it must demonstrate. (3 marks) [10]

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