Clinical Approach to Seizures and Syncope (Hon)

Question 1

Epilepsy is generally defined as?

Answer 1

2 or more unprovoked seizures

Question 2

What type of seizure is there a high likelihood (90%) that you will have positive findings for epilepsy on a single EEG?

Answer 2

Petit mal seizure (absent seizure)

Question 3

What type and how many EEGs should be performed for positive findings for all types of epilepsy?

Answer 3

3 sleep-deprived EEGs

Question 4

Although the EEG is an important tool in the diagnosis of epilepsy, what is the single most important information?

Answer 4

History of the event (preferably by witnesses)

Question 5

How can seizures be classified?

Answer 5

1) Partial seizures

2) Generalized seizures

Question 6

What happens in a partial seizure

What types of seizures fall under Partial Seizure?

Answer 6

Activity begins on one side of brain

Simple partial
Complex partial
Secondarily generalized (Partial onset)

Question 7

What falls under Generalized Seizures

Answer 7

Absence (Petit mal)
Tonic-Clonic
Myoclonic
Tonic
Clonic
Atonic
Clonic-Tonic-Clonic

Question 8

Adult onset seizures almost always come from what seizure classification?

Answer 8

Partial seizure

Question 9

How is simple partial seizure characterized?

Is there loss of consciousness?

How long does it last?

Is there a post-ictal state?

Answer 9

1) Focal motor or sensory activity
2) No loss of consciousness
3) Lasts seconds
4) No post-ictal state

Question 10

How is complex partial seizure characterized?

Is there loss of consciousness?

How long does it last?

Is there a post-ictal state?

Answer 10

1) Nonresponsive staring with possible preceding aura
2) Yes
3) 1-3 minutes
4) Yes

Question 11

How is secondary generalized seizure characterized?

Is there loss of consciousness?

How long does it last?

Is there a post-ictal state?

Answer 11

1) Bilateral tonic-clinic activity
2) Yes
3) 1-3 minutes
4) Yes

Question 12

How are absence seizures characterized?

Is there loss of consciousness?

How long does it last?

Is there a post-ictal state?

Answer 12

1) Nonresponsive staring, rapid blinking, chewing, and clonic hand motions
2) Yes
3) 10-30 seconds
4) No

Question 13

How are tonic-clonic seizures characterized?

Is there loss of consciousness?

How long does it last?

Is there a post-ictal state?

Answer 13

1) Bilateral extension followed by symmetrical jerking of extremities
2) Yes
3) 1-3 minutes
4) Yes

Question 14

How are atonic seizures characterized?

Is there loss of consciousness?

How long does it last?

Is there a post-ictal state?

Answer 14

1) Sudden loss of muscle tone, head drops, or patient collapses
2) Yes
3) Variable
4) Yes

Question 15

How are myoclonic seizures characterized?

Is there loss of consciousness?

How long does it last?

Is there a post-ictal state?

Answer 15

1) Brief, rapid symmetrical jerking of extremities and/or torso
2) Yes
3) Few seconds
4) Minimal

Question 16

What antiepileptic drug should be avoided in pregnant women because of its strong teratogenic effects?

What should be used instead?

Answer 16

1) Valproic acid

2) Levetiracetam

Question 17

What combination of AED’s has been shown to be synergistic in the treatment of epilepsy (especially for primary generalized seizures)?

Answer 17

Valproic acid and lamotrigine

Question 18

Ethosuximide is used for what type of seizure only?

Answer 18

Absence seizure

Question 19

Status Epilepticus is a condition characterized by?

Answer 19

Prolonged seizure (generally greater than 10 minutes) or repeated seizures without recovery in between

Question 20

In the treatment for status epilepticus, what should you give immediately to buy time before landing on a longer lasting AED?

Answer 20

Benzodiazepine

Question 21

In cases where a patient may only respond to one of the oral anticonvulsants (e.g. carbamazepine) what should be done?

Answer 21

Place a nasogastric tube

Question 22

What is a general principle in the treatment of patients with epilepsy?

Answer 22

Try to use monotherapy

Question 23

While all women of child-bearing age should be taking Folic acid, why is this particularly important in women with epilepsy?

Answer 23

AED’s are folate-depleting

Question 24

How can syncope present?

Answer 24

1) Pallor
2) Sweating
3) Abnormal head sensation
4) Lightheadedness
5) Slow onset
6) Brief unconsciousness

PB LASS

Question 25

Transient global amnesia is characterized as?

Answer 25

Sudden, temporary, isolated episode of loss of memory with no other neurologic symptoms