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NEUROSAE 2018 ANNUAL MEETING EDITION (VOLUME 10, ISSUE 3)
QUESTION 61 OF 100
A 32-year-old man presents with recurrent convulsions. Each episode lasts 10 to 15 minutes and is characterized by closed eyes and irregular clonic movements. Video EEG is obtained due to the frequency of convulsions. The EEG shown is a representative ictal event. Which of the following is the most appropriate next step in management?
A. Initiate a loading dose of levetiracetam followed by maintenance dosing.
B. Initiate a loading dose of fosphenytoin, followed by maintenance dosing.
C. Initiate a loading dose of lacosamide, followed by maintenance dosing. **
D. Administer a placebo of IV saline to the patient and continue monitoring
E. Refer the patient for psychiatric consultation with counseling.
** = Your answer
The clinical presentation is consistent with nonepileptic events. Clues include irregular, nonrhythmic clonic movements and eye closing during an episode. The sample EEG shows a normal posterior dominant rhythm during the ictal event therefore there is no indication to give a placebo IV administration. Psychiatric evaluation is indicated with counseling is indicated.
* Syed TU, LaFrance WC Jr, Kahriman ES, et al. Can semiology predict psychogenic nonepileptic seizures? A prospective study. Ann Neurol. 2011 Jun;69(6):997-1004.