Epilepsy and Seizure Disorders — WACS Viva & Clinical Scenarios (Neurology)

Exam-style epilepsy and seizure disorders viva scenarios with examiner probes and model answers for Internal Medicine candidates.

Scenarios covered

• SCENARIO 1: A 24-year-old female presents to the emergency department with continuous generalized tonic-clonic convulsions lasting 15 minutes without recovery of consciousness. Outline the immediate resuscitation steps and phased pharmacological protocol for managing convulsive status epilepticus.
• SCENARIO 2: A 28-year-old woman with a history of juvenile myoclonic epilepsy, currently controlled on sodium valproate, presents for preconception counseling. Detail the risks associated with valproate in pregnancy, your approach to preconception management, antiseizure medication modification, and pregnancy counseling.
• SCENARIO 3: A 45-year-old male is brought to the medical clinic following a first-ever unprovoked generalized convulsion. Describe the systematic clinical evaluation, diagnostic workup, and clinical criteria required to establish a diagnosis of epilepsy versus an isolated unprovoked seizure.
• SCENARIO 4: Contrast the pharmacological mechanisms of action, clinical indications, significant adverse effect profiles, and potential drug-drug interactions of sodium channel-blocking antiseizure medications versus broad-spectrum agents acting on synaptic vesicle glycoprotein 2A (SV2A) or GABAergic pathways.
• SCENARIO 5: Discuss the differential diagnosis of transient loss of consciousness, highlighting key clinical semiology features and investigations that distinguish epileptic seizures from psychogenic non-epileptic seizures and vasovagal or cardiogenic syncope.