Counselling · Intermediate · Paediatrics

Recent Epilepsy Diagnosis in Child

Practise this PLAB 2 counselling station on Childhood Epilepsy. 8-minute voice AI simulation with feedback on all 3 marking domains.

Clinical scenario

You are an FY2 doctor in primary care. Mrs Bridie Bain has brought her five-year-old daughter Emma to discuss her new epilepsy diagnosis. Emma was recently diagnosed at the hospital and started on anti-epileptic medication. The family is anxious about the diagnosis and its implications. Please counsel the parent on the condition, medications, safety measures, and school considerations.

Background notes: PMH: Nil significant

What this station tests

  • School IHP and staff seizure training including buccal midazolam
  • Bathing safety: shower preferred, no locked doors, supervised swimming
  • First aid: recovery position, do not restrain, 999 if over 5 minutes
  • Medication adherence as critical for seizure control
  • Reassuring about normal childhood with appropriate precautions

How to use your 8 minutes

  • 0-1 min — Introduction: Introduce yourself, establish what patient already knows and understands.
  • 1-3 min — Explain Condition: Explain diagnosis or condition using chunk-and-check technique. Use simple language, avoid jargon.
  • 3-5 min — Management Options: Discuss treatment options. Shared decision-making. Risks, benefits, alternatives.
  • 5-7 min — Address Concerns: Explore and address specific concerns. Check understanding. Discuss lifestyle implications.
  • 7-8 min — Closing: Summarise agreed plan. Safety netting. Arrange follow-up. Written information offer.

Consultation approach

The opening

Counselling parents of a newly diagnosed epileptic child requires covering medication, school, safety, and the emotional impact on the family. Mrs Bain is 42, a teacher, bringing 5-year-old Emma who was recently diagnosed. She is tired, stressed, and anxious. Open with: 'Mrs Bain, I know Emma's diagnosis has been a lot to take in. What questions are most on your mind?'

Core approach

Let her agenda lead. She will have practical concerns: school safety, medication side effects, and whether Emma can live a normal life. Medication: Emma is likely on sodium valproate or levetiracetam. Explain adherence is critical: missing doses increases seizure risk. Common side effects to watch for. The school must be informed: an individual healthcare plan (IHP) should be in place with trained staff who know what to do if Emma has a seizure.

Safety at home: supervised bathing (shower preferred over bath), no locked bathroom doors, swimming only with a designated adult who knows about epilepsy, kitchen safety (avoid unsupervised cooking as she grows). Heights and climbing: supervised play is fine, do not restrict normal childhood activity.

First aid for seizures: place on her side, protect her head, do not restrain, do not put anything in her mouth, time the seizure, call 999 if over 5 minutes. Emergency rescue medication (buccal midazolam) may be prescribed for prolonged seizures: school staff need training to administer.

Address the emotional dimension. Mrs Bain has two other children and is managing work alongside a new diagnosis. Offer Epilepsy Action for family support.

Closing and safety netting

Reassure about Emma's future. 'Most children with epilepsy are well-controlled on medication and lead completely normal lives. Many grow out of epilepsy by adolescence.' She can attend school normally, play with friends, and participate in most activities with appropriate precautions.

Follow-up: epilepsy specialist nurse review. Annual epilepsy review in primary care. Safety net: 'If Emma has a seizure lasting more than 5 minutes, has repeated seizures without recovery between them, or develops new symptoms like drowsiness or behavioural changes, come in urgently.' Offer a follow-up appointment for Mrs Bain to discuss further questions once she has had time to process.

How examiners mark this station

Examiners will assess your ability to explain childhood epilepsy and its management in a patient-centred way. Domain 2 (Clinical Management) and Domain 3 (Interpersonal Skills) are equally weighted and primary. Expect marks for accurate information delivery, shared decision-making, chunk-and-check technique, and addressing the patient's specific concerns. Domain 1 (Data Gathering) is assessed through how well you establish the patient's baseline understanding and elicit their concerns.

Domain 1 (Supporting)

Scores well: Medication checked. Safety needs assessed. School situation explored. Family context understood.

Costs marks: Not checking medication. Not assessing school.

Domain 2 (Primary focus)

Scores well: School IHP recommended. Safety advice (bathing, swimming). First aid taught. Buccal midazolam explained. Epilepsy Action signposted.

Costs marks: No school plan. No safety advice. No first aid.

Domain 3 (Primary focus)

Scores well: Following parent's agenda. Acknowledging emotional burden. Reassuring about normal life. Offering follow-up for further questions.

Costs marks: Lecturing. Not acknowledging stress. Over-restricting.

Common examiner feedback (and how to fix it)

Did not provide adequate explanation or plan to the patient

Fix: Use chunk-and-check: deliver one concept, check understanding, then move to the next. Offer all relevant treatment options with risks and benefits before helping the patient decide.

Did not sufficiently recognise or respond to the patient's feelings, concerns, or expectations

Fix: Before and during counselling, explicitly ask what concerns the patient most. Respond to emotional cues with empathic statements before continuing with information.

Common mistakes in this station

  1. Not addressing school management: an IHP is essential and staff must be trained
  2. Restricting normal childhood activities excessively: supervised play is fine, isolation is harmful
  3. Not teaching seizure first aid: parents and school need clear, practical instructions

Resitting PLAB 2?

If counselling stations have been a challenge, the most common issue is information overload: delivering too much clinical detail without checking understanding. Practise the chunk-and-check technique until it becomes automatic. Remember that shared decision-making, not lecturing, is what scores highly in Domain 3.

Example opening

Hello, my name is Dr [Name]. I understand you've come in today to discuss [topic]. Before I explain things, could you tell me what you've been told so far, so I know where to start?

Frequently asked questions

What is the best way to structure this childhood epilepsy counselling consultation?

Counselling parents of a newly diagnosed epileptic child requires covering medication, school, safety, and the emotional impact on the family. Mrs Bain is 42, a teacher, bringing 5-year-old Emma who was recently diagnosed. She is tired, stressed, and anxious.

Where are marks won and lost in this childhood epilepsy station?

Examiners reward: Medication checked. Safety needs assessed. School situation explored. Family context understood. Candidates are penalised for: Not checking medication. Not assessing school.

Where do candidates most often go wrong in this station?

Not addressing school management: an IHP is essential and staff must be trained. Another frequent error: Restricting normal childhood activities excessively: supervised play is fine, isolation is harmful.

Can I do well in this station without real-world experience of childhood epilepsy?

Structure beats experience here. Focus on bathing safety: shower preferred, no locked doors, supervised swimming. Use the domain breakdown on this page to target your preparation, then practise the station aloud so your structure survives exam pressure.

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