MCQs on Seizure Disorders

Written by Dr. James Whitfield (MBBS, FRACGP) – General Practitioner

Question 1

A 28-year-old man is brought to the Emergency Department by his partner after experiencing a generalized tonic-clonic seizure at home. This is his first seizure. The event lasted approximately 2 minutes, followed by a postictal phase of confusion lasting 15 minutes. He has no past medical history and does not take any medications. He denies alcohol or recreational drug use. There is no family history of epilepsy. His physical and neurological examinations are normal. Vital signs are stable. Blood glucose, serum electrolytes, renal and liver function tests are within normal limits. A CT scan of the head is unremarkable.

Which one of the following is the most appropriate next step in the management of this patient?

A) Start long-term antiepileptic therapy.
B) Admit for 24-hour video EEG monitoring.
C) Arrange outpatient MRI brain and EEG.
D) Reassure and discharge with no further investigations.
E) Perform lumbar puncture immediately.

Correct Answer: C) Arrange outpatient MRI brain and EEG.

In a patient presenting with a first unprovoked seizure, the goal is to evaluate for underlying structural, metabolic, or electrical abnormalities. While immediate treatment with antiepileptic drugs is not routinely indicated after a first seizure, further investigation is essential to assess risk of recurrence and guide future management.

Neuroimaging is important to exclude structural brain lesions. Although a CT scan is often performed acutely to rule out emergencies (e.g., hemorrhage or mass), MRI is more sensitive for detecting cortical abnormalities (e.g., hippocampal sclerosis, cortical dysplasia, low-grade gliomas).

EEG helps to identify epileptiform activity and classify seizure type. Abnormal EEG findings can significantly raise the risk of recurrence and influence the decision to initiate antiepileptic treatment.

There is no indication to start long-term antiepileptic therapy without further risk assessment. Routine lumbar puncture is not necessary unless there are signs of infection or raised intracranial pressure. Admission for video EEG is typically reserved for patients with diagnostic uncertainty or suspected non-epileptic events. Simply reassuring and discharging the patient without further evaluation would be inappropriate.

Question 2

A 35-year-old man is brought to the Emergency Department by ambulance. He has had continuous generalized tonic-clonic seizures for the past 12 minutes without regaining consciousness between episodes. He has a known history of epilepsy but has been non-compliant with his medications. On arrival, he is actively convulsing. His oxygen saturation is 92% on room air, blood pressure is 130/85 mmHg, and heart rate is 110 bpm. Intravenous access is secured.

Which one of the following is the most appropriate immediate next step in management?

A) Administer intravenous phenytoin.
B) Administer intravenous levetiracetam.
C) Administer intravenous lorazepam.
D) Perform rapid sequence intubation.
E) Order urgent CT brain.

Correct Answer: C) Administer intravenous lorazepam.

Status epilepticus is defined as a seizure lasting more than 5 minutes, or two or more seizures without full recovery of consciousness between them. It is a medical emergency associated with significant morbidity and mortality if not rapidly treated.

The first-line treatment is administration of a benzodiazepine, typically intravenous lorazepam (4 mg IV given slowly), due to its rapid onset of action and longer duration of effect compared to diazepam. If IV access is unavailable, alternatives include intramuscular midazolam or rectal diazepam.

If seizures persist after initial benzodiazepine therapy, second-line agents such as phenytoin, fosphenytoin, or levetiracetam should be administered.

(Option A and B) These are second-line treatments and are used after initial benzodiazepine administration.
(Option D) Intubation may be required if airway compromise occurs, but it is not the immediate next step before benzodiazepine administration.
(Option E) CT brain is important to identify underlying causes, but it should be performed after stabilizing the patient, not as an initial step during active seizure.

Question 3

A 7-year-old girl is brought to your clinic by her teacher, who reports that the child has frequent episodes of “daydreaming” in class. During these episodes, the child suddenly stops talking or doing an activity, stares blankly for about 10 seconds, and then resumes her activity as if nothing happened. She is unaware of the events and has no memory of them. There are no convulsive movements, postictal confusion, or urinary incontinence. Her development and academic performance are otherwise normal.

Which one of the following is the most appropriate initial investigation to confirm the diagnosis?

A) Brain MRI.
B) Electroencephalogram (EEG).
C) Serum glucose level.
D) CT brain.
E) 24-hour ambulatory EEG.

Correct Answer: B) Electroencephalogram (EEG).

This child’s symptoms are highly characteristic of absence seizures, a type of generalized non-motor (petit mal) seizure typically seen in children aged 4 to 10 years. These seizures involve brief episodes (usually <20 seconds) of impaired awareness, often described as staring spells, without convulsions, aura, or postictal confusion. The child typically resumes activity immediately after the event.

The most appropriate initial test is an EEG, which usually shows a classic pattern of 3 Hz spike-and-wave discharges during hyperventilation or spontaneously. This confirms the diagnosis.

(Option A and D) Imaging (MRI or CT) is not routinely indicated in typical cases of absence seizures unless the presentation is atypical or there are focal neurological signs.
(Option C) Serum glucose might be considered to rule out hypoglycemia, but it is not specific or diagnostic for seizures.
(Option E) A routine EEG with hyperventilation is usually sufficient. A 24-hour ambulatory EEG may be used later if diagnosis is unclear.

Previous Next

1. Neurology Module

1.1 Cerebrovascular Disorders

1.2 Cranial Nerves

1.3 Spinal Cord

1.4 Peripheral Nerves

1.5 Headaches

1.6 Seizure Disorders

1.7 Movement Disorders

1.8 Neuroimaging

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