AES self test questions Flashcards by Leonardo Bonilha

A 14-year-old girl is being started on an antiepileptic drug after 3 unprovoked seizures. How should you counsel her and her parents with regard to reproductive health?

Counsel her on the teratogenic risks as part of choice in treatment

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A 24-year-old graduate student has new-onset epilepsy and is concerned about the potential cognitive side effects of antiepileptic drugs. Which set of antiepileptic drugs listed below poses the lowest overall risk for cognitive side effects?

Gabapentin, Lamotrigine and LVT

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A 56-year-old right-handed man is undergoing a routine EEG because he had a recent seizure. The EEG’s sensitivity is at 7 microvolts/mm and filter settings are 1.0 – 70 Hz. What is the most appropriate interpretation of the displayed EEG page?

Mu rhythm

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A 78-year-old man is admitted with an intracerebral bleed. An EEG is obtained because of the patient’s altered mental status. What is the most appropriate interpretation of the displayed EEG page?

PLEDs

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An 83-year-old man has a cardiac arrest at home. He is resuscitated and brought to the hospital. An EEG is obtained. What is the most appropriate interpretation of this sample, which is representative of the entire EEG?

BS and right frontal sharp waves

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A 16-year-old boy with new-onset epilepsy is being started on an antiepileptic drug (AED). His parents are concerned about potential side effects of the AED. Which of the following statements about the neuropsychological effects of AEDs is the most accurate?

AEDs can affect psychomotor speed, vigilance and risk is increased with rapid titration, higher dose and polytherapy

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A 24-year-old woman is planning to marry and seeks advice about the potential teratogenic risks from antiepileptic drugs. Based on current human evidence, when used as monotherapy, which set of antiepileptic drugs below poses the lowest overall risk for major congenital malformations from fetal exposure?

CBZ, LMT and LVT

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A 72-year-old man is admitted with an intracerebral bleed. An EEG is obtained in the ICU. The patient is comatose and is being mechanically ventilated. What is the most appropriate interpretation of the displayed EEG page?

Artifact (ventilator) and low voltage background.

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A 36-year-old man with treatment-resistant focal epilepsy has undergone electrode implantation that includes the displayed 2 x 8 grid placed at the left inferior temporal lobe. Contacts #1 through 9 are most medial and contacts #8 through 16 are most lateral. The “X” marks the onset of the patient’s aura. Assuming no epileptiform activity at his seizure onset is seen in any additional electrodes that are not shown, what is the most appropriate interpretation of the displayed EEG page?

The area of seizure onset is not covered by electrodes.

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A 28-year-old woman has medically resistant epilepsy. The figure displays her interictal PET scan and MRIs with FLAIR and T1 images. What findings are most pertinent to her epilepsy?

Right frontal FCD

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Which one of the following semiologic features suggests psychogenic nonepileptic seizures rather than epileptic seizures?

Stuttering speech during seizure

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A 19-year-old man presents with a history of brief episodes of thrashing movements that occur in clusters during sleep. His disorder is most likely to be associated with mutations in which gene(s)?

Genes encoding the nocotinic Ach receptor

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Which of the following HLA alleles is associated with the highest risk of carbamazepine-induced Stevens-Johnson syndrome and toxic epidermal necrolysis?

HLA-B 1502

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Which type of aura is most likely to be associated with seizures of mesial temporal origin?

Abdominal

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What is the name of the area of cortex capable of generating interictal spikes on EEG or MEG?

Irritative zone

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A 40-year-old man presents with frequent (up to 50 per day), very brief (3 to 4 seconds) dystonic seizures affecting one arm and the ipsilateral face or leg. Subsequently, he develops amnesia, confusion, hallucinations, and sleep disturbances. He is most likely to have high levels of which antibody?

Anti-LGI1

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Traumatic brain injury is thought to cause cortical hyperexcitability as a result of multiple mechanisms, including which of the following?

Reduced GABAergic inhibition due to loss of inhibitory interneurons

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Which of the following statements regarding the role of copy number variants in epilepsy is correct?

Copy number variants are more common in individuals with generalized epilepsy and intellectual disability than in individuals with only generalized epilepsy.

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Which of the following statements regarding migraines and epilepsy is correct?

People with epilepsy are at increased risk of migraine and people with migraine are at increased risk of epilepsy.

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Adjunctive therapy with which of the following AEDs is most likely to cause increased aggression as a side effect, particularly in adolescents?

Perampanel

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Which of the following seizure models is used as the initial “gatekeeping” screen by the NINDS Anticonvulsant Screening Program (ASP) despite failing to identify the efficacy of levetiracetam?

Maximal electroshock (MES)

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Which of the following statements regarding neurostimulation for the treatment of treatment-resistant right lesional temporal lobe epilepsy is correct?

Responsive neurostimulation, vagus nerve stimulation, and thalamic stimulation are all less effective than resective surgery.

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Which one of the following AEDs may aggravate seizures in juvenile myoclonic epilepsy?

Lamotrigine

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Which of the following characteristics most strongly suggests psychogenic nonepileptic seizures?

Seizure in the office and history of fibromyalgia and chronic pain

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Which of the following is an advantage of subdural grid recordings over intracerebral depth electrode recordings?

Ability to record functional information from the cortex.

Which of the following statements regarding diffusion tensor imaging in epilepsy is true?

Technical challenges for diffusion tensor–based tractography include the presence of crossing fibers. Flag for Review

Which of the following is not essential in an epilepsy protocol MRI scan?

Gadolinium

In temporal lobe epilepsy, depression may be associated with hyperexcitability of the network that includes the hippocampus and what other structure?

Inferior frontal lobe (BA 25)

Genomic testing and genetic diagnosis of nonlesional epilepsies such as Severe Myoclonic Epilepsy of Infancy rest on which of the following?

Detailed clinical assessment complemented with analysis of the SCN1A gene single-nucleotide polymorphisms and copy number variants

Combined EEG and fMRI is a useful method in the investigation of the epileptic focus for which principal reason?

It is a noninvasive means of investigating the whole brain.

Epilepsy monitoring unit studies assessing patients' recall of seizures reveal which of the following?

There is a greater incidence of loss of memory in left temporal lobe seizures.

Which lesion is most easily visualized on a routine MRI of patients with epilepsy?

Cavernoma with hemorrhage

The most common histopathological subtype of hippocampal sclerosis in the ILAE consensus classification shows which of the following?

Cell loss in CA1 and CA4 regions

How frequent is atypical language dominance in temporal lobe epilepsy?

20-30%

Which two fiber tracts have been implicated in verbal memory performance in patients with temporal lobe epilepsy?

Uncinate and inferior longitudinal fasciculus.

Which of the following measurements can be derived from diffusion tensor imaging data?

Approximately what percentage of newly diagnosed patients with epilepsy ultimately achieve seizure freedom for 1 year or more once started on AEDs?

68%

Which of the following statements about the point prevalence of epilepsy in the USA nursing home population is correct?

60 per 1000 (6%)

Which pair of antiepileptic drugs is least likely to be affected by drug–drug interactions?

LVT and gabapentin

Which of the following AEDs does not reduce the efficacy of oral contraceptive pills?

VPA

Which temperature range for induced systemic hypothermia has been demonstrated to terminate status epilepticus in humans?

31-35 degrees celcius

Pregnancy registries have consistently demonstrated that the risk of congenital malformations is which of the following?

Greater with valproate than with carbamazepine and lamotrigine

What is the acknowledged study design for obtaining FDA approval for the use of an antiepileptic drug as monotherapy?

Conversion to monotherapy superiority design

Which of the following has been shown to be a biomarker of the epileptogenic zone?

Pathologic high-frequency oscillations

If a person has had a skin rash as a side effect of carbamazepine, which AED is most likely to also produce a skin rash (due to cross-reactivity)?

Phenytoin

Which commonly used natural product induces CYP3A4, CPY2C19, CYP2C9, and the P-glycoprotein transporter, thus affecting the concentrations of many AEDS?

St Johns Wort

Complete the following sentence. Measuring serum concentrations of antiepileptic drugs (AEDs) is

Useful for establishing an individual therapeutic concentration once a person has attained the desired clinical outcome.

The most important factor in determining the clearance of phenytoin, and thus its dose in an individual, is which of the following?

Genetics

There is Class I evidence for the use of which drug in the treatment of convulsive status epilepticus?

Phenytoin

The most common serious psychosocial issue facing a person with epilepsy may be which of the following?

Depression or anxiety

Mutations in which of the following genes are associated with both hemiplegic migraine and epilepsy?

CACNA1A – P/Q-type calcium channels

What are the risks for minor and major neurologic complications following extratemporal epilepsy surgery?

12% and 6.5%, respectively

Complete the following sentence. Seizures associated with focal epilepsy

Often cluster temporally

Complete the following sentence. A patient with epilepsy and a nonlesional MRI

Has a lower seizure-free rate after surgery than a patient with a lesion.

The Americans with Disabilities Act (ADA) of 1990 prohibits employers from discriminating based on a potential employee's disabilities. What are potential employers permitted to ask about?

The employee's ability to perform specific functions required for the job

For Childhood Absence Epilepsy, without convulsions, the most appropriate initial antiepileptic drug is:

Ethosuximide

What is the antiepileptic drug whose concentration fluctuates the most significantly during pregnancy?

Lamotrigine

When may people with epilepsy operate noncommercial motor vehicles in the USA?

It depends on the law of the state in which they reside.

Which non-antiepileptic drug is likely to significantly decrease carbamazepine concentrations?

Grapefruit juice

Complete the following sentence. Quantitative structural neuroimaging studies have revealed that anatomical abnormalities in temporal lobe epilepsy with hippocampal sclerosis

Can be extensive, encompassing temporal and extratemporal lobe structures.

Functional magnetic resonance imaging (fMRI) studies for language lateralization revealed higher incidences of bilateral or right lateralized language activation (i.e., atypical language lateralization) in epilepsy patients compared to controls. Of the following, what is the most important factor associated with atypical language lateralization?

Early seizure onset

Complete the following sentence. Intracarotid amobarbital testing (the Wada test):

Scores may predict verbal memory outcomes following left anterior temporal lobe surgery.

Which of the following statements distinguishes responsive neurostimulation from anterior thalamic deep brain stimulation?

Responsive neurostimulation senses electrographic activity and then provides stimulation. Anterior thalamic deep brain stimulation provides stimulation at a constant time interval.

What is the most common identifiable etiology of epilepsy in the elderly?

Stroke

Which of the following is a true statement about factors that may contribute to cognitive deficits in elderly patients with chronic epilepsy?

Individuals with chronic epilepsy are exposed to many risk factors associated with abnormal brain aging, including vascular, inflammatory, and lifestyle risk factors.

With regard to patients with MRI-negative epilepsies, which of the following statements is true?

Subtraction ictal single-photon emission computed tomography coregistered to MRI (SISCOM) has greater clinical utility in localizing the epileptogenic focus in extratemporal lobe epilepsy than in temporal lobe epilepsy.

Which of the following complications of hemispherectomy (either anatomic or functional) occurs in nearly 25% of children who have this procedure?

Hydrocephalus requiring shunting.

Which of the following statements is correct about the EEG finding commonly termed “delta brush”?

Normal in preterm babies of less that 37 weeks gestation.

A 5-year-old child was seen in the emergency room at 4:00 am due to a seizure. The parents reported that the child awakened and complained that she felt sick. She then proceeded to vomit several times and looked very pale. She was observed to have leftward ocular and head deviation and contortion of the left face. While she was not able to respond initially, she was speaking upon arrival in the emergency room. Both general and neurological examinations were normal. The child has no prior history of such events or other paroxysmal episodes. Her past medical, developmental, and family histories are unremarkable. CT scan was normal. An EEG was ordered. When seen 4 days later she has had no further seizures. Neurological exam is normal. What is her most likely diagnosis, and what do you expect her EEG to show?

Panayiotopoulos syndrome. Her EEG would show high-amplitude repetitive bilateral synchronous or asynchronous parieto-occipital sharp waves and spike waves in the awake and asleep states with fixation-off sensitivity.

Which of the following statements about GEFS+ is true?

Originally, the term GEFS+ was a short name for generalized epilepsy with febrile seizures plus. After later studies showed such pedigrees may be associated with frontal or temporal lobe focal seizures, the term came to denote genetic epilepsy with febrile seizures plus.

The primary concern of adult neurologists who have responded to questionnaires about assuming the care of young adults with pediatric-onset epilepsy have centered on which of the following?

Insufficient information about past history is received from the child neurologist, and the patient often does not know enough about his or her past medical history.

What is a common clinical feature of patients who have SUDEP or near-SUDEP in a monitored setting (i.e., an epilepsy monitoring unit)?

A pattern of rapid breathing (over 15 breaths per minute) occurs after a generalized convulsion.

A 12-year-old boy was brought in by his parents after having a generalized tonic-clonic seizure in sleep. His EEG is below. He likely has which of the following?

Benign Rolandic Epilepsy

A 17-year-old right-handed female is evaluated for spells characterized by vocalizations, thrashing movements of the arms, and rocking movements of the trunk and body. Each spell lasts about 30 seconds. She does not respond during the spell but appropriately answers questions within 15 seconds after movement cessation. Over 50% of the spells occur in sleep. What do these spells likely represent?

Frontal lobe seizures

A 16-year-old female has a 2 year history of bilateral arm and shoulder twitching movements soon after awakening. She also has rare generalized convulsions that are usually associated with sleep deprivation and increased stress. An EEG taken in the EMU shows generalized spike-wave and polyspike-wave discharges. In the EMU, she has a seizure characterized by clonic turning of her head and eyes to the left, followed by tonic extension of the left arm and flexion of the right arm that progresses to generalized stiffening and jerking. She likely has which of the following?

JME

A 25-year-old female has pharmacoresistant focal epilepsy characterized by right upper extremity paresthesias with occasional evolution to bilateral convulsions on a monthly basis. Her 3T MRI is normal, and her MEG and ictal SPECT do not provide informative localizing or lateralizing information. The patient undergoes intracranial EEG monitoring with subdural grid electrodes (as shown in the grid map; FRONT = anterior frontal 6 x 6 grid; PART = frontoparietal 6 x 6 grid; MIDT = mid-temporal 1 x 6 strip). During 5 days of monitoring, 2 habitual seizures with a similar electrographic onset pattern are captured (1 seizure shown in the EEG tracing). Which of the following is the best management recommendation?

Movement of frontoparietal grid posteriorly by 2-3 cm and re-monitoring for additional seizures

A 32-year-old male has a 10 year history of pharmacoresistant focal seizures with occasional evolution to convulsions. Seizures captured on scalp video-EEG have an electrographic onset lateralized to the right hemisphere. His 3T MRI and FDG-PET scans are normal. Neuropsychometric testing shows mild deficits in verbal memory. Ictal SPECT does not demonstrate any focal areas of hyperperfusion. For this type of challenging pharmacoresistant epilepsy case, which of the following statements about magnetic source imaging (MSI or MEG) is true?

It provides crucial information for management planning in 10-15% of cases.

A 33-year-old female presented 5 months ago with a history of severe headache and a nocturnal generalized convulsive seizure. Her initial workup revealed a right frontal 2 cm arteriovenous malformation with evidence of recent hemorrhage. She has had three nocturnal generalized convulsive seizures since. Her neurological examination is normal. She has tried a new antiepileptic drug after each breakthrough seizure and has been on therapeutic doses of levetiracetam, oxcarbazepine, and lacosamide. She and her husband are interested in stereotactic radiosurgery. Which factor suggests that she is less likely to be seizure free after radiosurgery?

She presented with a seizure in the setting of hemorrhage.

A 23-year-old male has Lennox-Gastaut syndrome with generalized tonic-clonic and atonic seizures. His seizures were poorly controlled on triple anticonvulsant therapy (levetiracetam, rufinamide, and clobazam), so a vagus nerve stimulator (VNS) was implanted. One month later, at a follow-up visit, his caretakers state that the patient’s voice is intermittently hoarse and that his seizure frequency has changed minimally since VNS implantation. Which of the following statements represents an appropriate response to the caretakers?

The hoarseness is temporary; the seizures may improve over time.

What is the most common side effect of deep brain stimulation of the anterior thalamus?

Depression

Vagus nerve stimulation (VNS) is FDA approved for which of the following patients?

Patient with TLE

Vigabatrin works by which of the following mechanisms?

GABA transaminase inhibition

What is thought to be the likely mechanism of action of levetiracetam?

Binding of synaptic vesicle protein SVA2

Which of the following statements about the ketogenic diet is true?

It is the treatment of choice for glucose transporter type 1 deficiency syndrome (GLUT1 deficiency or DeVivo disease).

A 9-year-old girl has been taking carbamazepine for focal dyscognitive (complex partial) seizures. Her most recent carbamazepine level, taken one month ago, was 9.3 mcg/mL. Last week, the child developed an upper respiratory tract infection and was started on erythromycin by her pediatrician. Two days later, the child became acutely ataxic and lethargic. Which of the following is the most likely explanation for the girl’s ataxia and lethargy?

Erythromycin interfered with carbamazepine metabolism, resulting in carbamazepine toxicity.

Terminology changes in the 2010 organization of epilepsies include which of the following?

Eliminating the term "simple partial seizure" and replacing it with "focal dyscognitive seizure"

Eslicarbazepine is now available in the US for the treatment of epilepsy. Which of the following statements is true?

The major adverse events are dizziness, somnolence, and headaches.

Which statement about intracranial EEG recording is correct?

In typical seizures associated with mesial temporal sclerosis, the seizure onset is usually seen earlier with hippocampal depth electrodes than with subdural strip electrodes over temporal structures.

Responsive neurostimulation is a recently approved treatment for the treatment of focal intractable epilepsy. In which of the scenarios listed below would RNS be most indicated?

A 54-year-old unemployed accountant with temporal lobe seizures who has a normal MRI but had an intracranial study that showed left and right hippocampal seizures

Which of the following statements about memory impairment, temporal lobe epilepsy, and epilepsy surgery is true?

A left temporal lobectomy frequently leads to verbal memory deficits, especially confrontation naming deficits.

A 30-year-old patient has absence seizures, generalized tonic-clonic seizures, and seizures with drop attacks. Her seizures are intractable to medication. Her MRI is shown below. Which of the following statements is true?

The patient has periventricular heterotopias

A patient reports seizures in which he first notices throat constriction, then some tingling of his face, followed by some right-sided motor activity with altered awareness. What is the most likely seizure onset zone?

The left insula

What are SIRPIDs?

An EEG waveform elicited by stimulation in critically ill patients.

A 46-year-old patient presents with the below CT scan and intractable epilepsy. Which of the following statements is true?

The inheritance pattern is sporadic.

Rational polypharmacy suggests using AEDs with different mechanisms of action. Which AED has a different mechanism of action from the other three?

LVT

Hyponatremia is most likely to be associated with which antiepileptic drug?

Oxcarb

The most current (2013) ILAE evidence review of AED initial monotherapy for epileptic seizures and syndromes in children and adults drew which of the following conclusions?

Both valproate and ethosuximide have Level A evidence supporting the use of either agent as initial monotherapy in childhood absence epilepsy.

The ILAE 2010 revised classification of seizures and epilepsy differs from the 1981/1989 classifications in which one of the following ways?

Subtypes of absence and myoclonic seizures have been added.

How long should continuous EEG monitoring be carried out for, in order to detect most of the seizures in non-comatose patients in the intensive care unit setting?

24 hours

This is the EEG of an 8-month-old infant. Which of the following statements is correct? Related Images click to expand contents

Hypsarrhythmia