Epilepsy Asking to Restart Her Medication After A Seizure — Free SCA Practice Case

Character Overview: You are Chelsea, a 23-year-old accountant with epilepsy diagnosed at 17. You stopped your carbamazepine about seven months ago on your own, because you had been seizure-free for a while and thought you no longer needed it. Last night you woke to find you had wet the bed and bitten your tongue — which only ever happens to you after a seizure — so you believe you had one in your sleep (unwitnessed; you live alone). Your usual seizures are generalised (whole-body jerking with loss of consciousness), usually preceded by a light-headed aura. You drive to work daily and are keen to keep doing so. You are in a new relationship (three weeks) and sexually active, considering moving in together. You want the doctor to restart your medication today.

Opening Sentence: "Hi Doctor. I'd like to restart my epilepsy medication, please. I think I had a seizure in my sleep last night — I woke up having wet the bed and bitten my tongue, which only happens to me after a fit."

History if Asked (Data Gathering Phase)

• ●Last night's episode: "I woke up having wet myself and with a bitten tongue — that only happens after a seizure. No one saw it; I was on my own."
• ●Her usual seizures: "Whole-body jerking, I lose consciousness. Usually I get a light-headed warning first, so I can lie down. Last night was different — no warning, in my sleep."
• ●Why she stopped the medication: "About seven months ago. I'd been seizure-free for a while, so I thought I didn't need it anymore. I stopped it myself."
• ●Last seizure before this: "About nine months ago."
• ●What she wants: "To restart my carbamazepine today."

ICE — Ideas, Concerns, Expectations

The patient does not volunteer this information unprompted. These responses surface only when the candidate directly explores her perspective.

• ●Ideas: Chelsea is unsure why the seizure happened, though she half-recognises stopping her medication may be relevant. "I'm not totally sure why it happened — maybe stopping the tablets?"
• ●Concerns: She is worried her seizures are coming back, and (once raised) about driving and her job. "I'm scared they're starting again. And I need to be able to drive for work."
• ●Expectations: She wants her medication restarted today. "I just want to get back on my tablets."

If Asked — Seizure, Trigger, Red-Flag, and Lifestyle Screen

The patient answers these only when directly asked.

• ●If asked about witnesses / post-ictal features (sleepiness, confusion, amnesia): "No witness. I was groggy and confused this morning, and my tongue's sore." (Post-ictal features.)
• ●If asked about triggers (sleep deprivation, alcohol, stress, illness, flashing lights, missed medication): "The obvious thing is I stopped my tablets. No alcohol, not especially sleep-deprived, no infection."
• ●If asked about red flags (persistent headache, visual change, focal weakness, fever, neck stiffness): "No headaches, no weakness, no fever or neck stiffness."
• ●If asked about frequency/pattern historically: "They'd been well controlled on the tablets, only occasional before I stopped."
• ●If asked about driving: "I drive to work every day. I really need to."
• ●If asked about occupation/high-risk activities: "I'm an accountant, mostly desk work — no machinery or heights."
• ●If asked about contraception and pregnancy plans: "I'm on no contraception really — we use nothing regular. I'm not planning pregnancy, but we're getting serious." (Relevant to carbamazepine.)
• ●If asked about alcohol/smoking/drugs: "I don't smoke, barely drink, no drugs."
• ●If asked about why she missed the neurology appointments: "Life got busy and I felt fine, so I didn't go."

Responses to Management (The Negotiation Phase)

• ●If the Doctor explains the seizure likely relates to stopping medication: "So stopping my tablets probably brought it back? I didn't realise it was that risky." (The tested point is explaining seizure-recurrence risk after stopping an antiepileptic.)
• ●If the Doctor restarts the medication and arranges review/bloods: "You'll restart my carbamazepine and check me over? Good." (The tested point is safely restarting the antiepileptic and arranging review.)
• ●If the Doctor raises driving cessation and the DVLA — key: "Wait — I have to stop driving and tell the DVLA? Even though it happened in my sleep? That's a real problem for me." (The tested point is clear, correct driving-cessation and DVLA advice.)
• ●If the Doctor raises re-referral to neurology: "So I need to see the epilepsy specialists again?" (The tested point is re-referral to neurology after loss of follow-up.)
• ●If the Doctor raises contraception/pregnancy: "My tablets affect contraception, and there are risks in pregnancy? I didn't know that." (The tested point is contraception and teratogenicity counselling with carbamazepine.)