Epilepsy

Question 1

What is a seizure?

1 - temporary disruption in brain function caused by abnormal firing of neurons
2 - temporary loss of consciousness
3 - temporary paralysis
4 - temporary contraction of all skeletal muscle

Answer 1

1 - temporary disruption in brain function caused by abnormal firing of neurons

• neurons can fire when they shouldn’t
• neurons don’t fire when they should
• together causes dysfunction

Question 2

A seizure is a temporary disruptions of brain function, caused by uncontrolled synchronous, paroxysmal excessive neuronal activity. It can present as a stereotype disturbance of consciousness, behaviour, emotion, motor function and/or sensation, which depends on which part of the brain is affected. How long do they generally last?

1 - seconds to minutes
2 - minutes to hours
3 - hours to days
4 - can be all of the above

Answer 2

4 - can be all of the above

Question 3

When defining the term epilepsy we need to understand 2 terms; provoked seizure and unprovoked seizure. In relation to epilepsy what does unprovoked seizure mean?

1 - cause of seizure is known
2 - cause of seizure is unknown
3 - cause of seizure or the precipitating factor is unknown
4 - all of the above

Answer 3

3 - cause of seizure or the precipitating factor is unknown

• no medically reversible cause (alcohol, blood glucose) can be identified

Question 4

What is a provoked seizure?

1 - cause of seizure is known
2 - cause of seizure is unknown
3 - cause of seizure is identified but not the precipitating factor
4 - cause of seizure or the precipitating factor is known

Answer 4

4 - cause of seizure or the precipitating factor is known

• diabetes, neurological disorder, alcohol withdrawal

Question 5

Epilepsy is chronic condition with the occurence of recurring and unpredictable seizures, where neurons in the brain fire when they should not. How many unprovoked (no known cause or precipitatking factor) seizures need to occur before a patient is diagnsoed with epilepsy?

1 - 1
2 - >2
3 - >4
4 - >10

Answer 5

2 - >2
- MUST be separated by >24 hours

Diagnosis also includes those who have had one seizure and and are >60% risk of subsequent seizures.

Question 6

What % of the population are affected by epilepsy?

1 - 0.1 - 1%
2 - 10-15%
3 - 15-30%
4 - 30-50%

Answer 6

1 - 0.1 - 1%

Question 7

Which 2 of the following are said to be the cause of seizures?

1 - too much neuronal excitation
2 - toxicity of neurotransmitters
3 - lack of neurotransmitters
4 - too much inhibitory neurotransmitter stimulus

Answer 7

1 - too much neuronal excitation
- increased glutamate binding NMDA receptors

4 - too much inhibitory neurotransmitter stimulus
- too much GABA binding GABA receptors

Question 8

Even in patients with a diagnosis of epilepsy, who are typically well controlled, they can still experience seizures. Which of following are causes of seizures in patients who are well controlled?

1 - inconsistent use of anti-epileptic medication
2 - lifestyle changes (increased stress, sleep deprivation, alcohol use)
3 - new medications / supplements interacting with anti-seizure medication
4 - estrogen supplements increase metabolism of lamotrigine (lowering serum levels) and pregnancy
5 - Infection
6 - all of the above

Answer 8

6 - all of the above

• inconsistent use of anti-epileptic medication is typically the most common cause

Question 9

Epilepsy is a chronic condition of recurrent seizures, where >2 unprovoked seizures is diagnostic that have occurred >24 hours apart or they have one seizure and are >60% risk of subsequent seizures. Are the seizures always of the vigorous shaking kind?

Answer 9

• no
• seizures can be brief and nearly undetectable symptoms to periods of vigorous shaking and convulsion
• all depends on part of brain affected

Question 10

In epilepsy we know that seizures are caused by abnormal firing of the neurons in the brain. Which part of the brain is generally affected in up to 60% of cases?

1 - frontal
2 - parietal
3 - occipital
4 - temporal

Answer 10

4 - temporal
- presents with lots of symptoms, including epigastric rising, olfactory/gustatory hallucinations, autonomic, affective, deja-vu; motor arrest and absence prominent (>30 seconds), automatisms, automatic speech, contralateral dystonia

Question 11

What is an automatism?

1 - voluntary movements following a seizure
2 - involuntary movement following a seizure
3 - coordinated involuntary motor activity
4 - voluntary coordinated movement

Answer 11

3 - coordinated involuntary motor activity
- auto = means happens automatically without control
- typically occur during the seizure
- typically associated with amnesia and impaired awareness

Question 12

Automatisms are coordinated involuntary motor activity that typically occur during the seizure and are typically associated with amnesia and impaired awareness. Anywhere can be affected, but which 2 of the following body parts are most commonly affected?

1 - mouth
2 - feet
3 - abdomen
4 - hands

Answer 12

1 - mouth
- chewing or lip smacking

4 - hands
- picking or fidgeting

Question 13

There are different things that can occur in seizures. Which of the following is the definition of prodrome?

1 - drowsy, confused, psychotic. Bitten tongue, lost continence
2 - feeling, sensations, changes in behaviour hours or days before the event
3 - actual event (may need witness description)
4 - immediately prior (not always present)

Answer 13

2 - feeling, sensations, changes in behaviour hours or days before the event
- a lot of the time it can be family or friends who aware of the changes

Question 14

There are different things that can occur in seizures. Which of the following is the definition of preictal/aura ?

1 - drowsy, confused, psychotic. Bitten tongue, lost continence
2 - feeling, sensations, changes in behaviour hours or days before the event
3 - actual event (may need witness description)
4 - immediately prior (not always present)

Answer 14

4 - immediately prior (not always present)

Question 15

There are different things that can occur in seizures. Which of the following is the definition of Ictal?

1 - drowsy, confused, psychotic. Bitten tongue, lost continence
2 - feeling, sensations, changes in behaviour hours or days before the event
3 - actual event (may need witness description)
4 - immediately prior (not always present)

Answer 15

3 - actual event (may need witness description)
- typically associated with amnesia

Question 16

There are different things that can occur in seizures. Which of the following is the definition of post-ictal ?

1 - drowsy, confused, psychotic. Bitten tongue, lost continence
2 - feeling, sensations, changes in behaviour hours or days before the event
3 - actual event (may need witness description)
4 - immediately prior (not always present)

Answer 16

1 - drowsy, confused, psychotic. Bitten tongue, lost continence

Question 17

Some patients may experience a preceding prodrome that can last hours to days prior to a seizure, typically of the temporal lobe causing a change in mood or behaviour. They can also experience an aura. Typically what do patients with an aura experience?

1 - strange feeling in the gut
2 - deja vu
3 - strange smells
4 - flashing lights
5 - all of the above

Answer 17

5 - all of the above

Question 18

What is the term given in epilepsy when a seizure affects both hemispheres?

1 - unprovoked
2 - generalised
3 - systemic
4 - central

Answer 18

2 - generalised

Question 19

Can partial / focal seizures develop into generalised seizures?

Answer 19

yes
- called a secondary generalised seizure

Question 20

Does a aura suggest a focal/partial or generalised seizure?

Answer 20

• focal seizure

Question 21

In epilepsy we know that seizures are caused by increased glutamater (excitatory) or GABA (inhibitory) that causes abnormal firing of the neurons in the brain. In up to 60% of cases it generally affected the temporal lobe, but can also spread/occur where?

1 - frontal
2 - occipital
3 - cerebellum
4 - all of the above

Answer 21

1 - frontal
- typically affects the frontal as well

• can affect both hemispheres
• parietal and occipital (rare)
• where seizures occurs affects how the patient presents

Question 22

In epilepsy, seizure can last for longer periods. If the seizure lasts >5 minutes in duration, what is this called?

1 - status epilepticus
2 - status provoctus
3 - status criticalis
4 - partial epilepticus

Answer 22

1 - status epilepticus
- latin for continous state of seizure

Question 23

Status epilepticus is when a seizure lasts longer >5 minutes in duration. Why is this serious?

1 - can increase risk of subsequent seizures
2 - increases risk of drug toxicity
3 - increases risk of self harm
4 - medical emergency

Answer 23

4 - medical emergency
- typically tonic-clonic affecting both hemispheres
- can lead to permanent brain damage and death
- mortality is between 10-15%

Question 24

Due to the seriousness of Status epilepticus, what medication can patients often be given to try and stop the seizure?

1 - typical psychotics
2 - benzodiazepines
3 - antiepileptics
4 - antidepressants

Answer 24

2 - benzodiazepines
- increases effects of GABA to try and control patients seizure

• administered by intravenously, mucosal or rectal

Question 25

What is the 1st line treatment for status epilepticus (SE)? 1 - diazepam 2 - carbamazepine 3 - lorazepam 4 - phenytoin

Answer 25

3 - lorazepam - 2-4mg given when SE confirmed - repeat 2-4mg after 5 minutes from 1st dose if continued - give Levetiracetam 5 minutes after 2nd dose of lorazepam if SE continues Phenytoin or Sodium Valproate may be used instead of Levetiracetam - if 30 minutes of SE then give propofol and anaesthetics needed

Question 26

Lorazepam is the 1st line treatment for status epilepticus. However, if a patient continues to have seizures, what medication should they be given? 1 - diazepam 2 - carbamazepine 3 - more lorazepam 4 - phenytoin

Answer 26

4 - phenytoin - need to monitor BP and ECG

Question 27

If a patient has been given lorazepam, and then phenytoin and the patient remains in status epilepticus for 60-90 minutes, what should the next treatment option be? 1 - double lorazepam and phenytoin dosages 2 - give rectal diazepam 3 - consider anaesthesia (propofol) 4 - all of the above

Answer 27

3 - consider anaesthesia (propofol) - patient will also need to be intubated with continuous EEG monitoring in ICU

Question 28

In a patient with status epilepticus, organise the emergency management of the patient from the below options: 1 - thiamine and glucose administered if malnourished 2 - IV access and bloods taken 3 - anaesthesia (propofol) with continuous EEG in ICU 4 - open and secure airway 5 - Oxygen @ 100% + suction as required 6 - lorazepam given as IV bolus 7 - correct hypotension as required

Answer 28

4 - open and secure airway 5 - Oxygen @ 100% + suction as required 2 - IV access and bloods taken 6 - lorazepam given as IV bolus 1 - thiamine and glucose administered if malnourished 7 - correct hypotension as required 3 - anaesthesia (propofol) with continuous EEG in ICU

Question 29

A generalised seizure is when both hemispheres are affected. There are subcategories of how the generalised seizures present. Which of the following is NOT a form of generalised seizure? 1 - tonic 2 - atonic 3 - complex partial 4 - clonic 5 - tonic-clonic 6 - myoclonic 7 - absence

Answer 29

3 - complex partial - tonic = stiff and flexed, patients fall backwards - atonic = relaxed, patients fall forwards - clonic = violent convulsions - tonic-clonic = mixture - myoclonic = small muscle twitches - absence = patient spaces out

Question 30

A generalised seizure is when both hemispheres are affected. There are subcategories of how the generalised seizures present. Which of the this subcategories is most common? 1 - tonic 2 - atonic 3 - clonic 4 - tonic-clonic 5 - myoclonic 6 - absence

Answer 30

4 - tonic-clonic - tonic = stiffening - clonic = twitching or jerking - phases of violent convulsions mixed with relaxed muscles

Question 31

What is the 1st line treatment for a patient having myoclonic seizures (myo = one, clonic = twitching or jerking), a form of generalised seizure, which can present with a muscle twitches to whole body spasms that can be brief? 1 - Carbamazepine 2 - Phenytoin 3 - Diazepam 4 - Levetiracetam 5 - Sodium Valproate

Answer 31

5 - Sodium Valproate - 2nd line is Levetiracetam

Question 32

In a generalised (affecting the the whole brain) tonic-clonic seizure, there is a tonic phase (stiffening of the body) followed by a clonic phase (violent/jerking of the body). In the image below which is tonic and which is clonic?

Answer 32

A = tonic - tonic (stiff) phase due to prolonged depolarization due to loss of GABA inhibition - affected tissue cannot relax B = clonic - clonic (jerk) phase due to some neuronal repolarization - following inactivity all tissues are stimulated quickly at one

Question 33

What is the 1st line medication for a patient who is having generalised tonic-clonic seizures? 1 - Carbamazepine 2 - Phenytoin 3 - Diazepam 4 - Levetiracetam 5 - Sodium Valproate

Answer 33

5 - Sodium Valproate - 2nd line could be Carbamazepine or Levetiracetam

Question 34

What is an absence seizure? 1 - a seizure where patients lose consciousness 2 - a seizure where patients lose awareness of their surrounding for a period of time 3 - a seizure that has a stiff followed by involuntary actions 4 - combination of all of the above

Answer 34

2 - a seizure where patients lose awareness of their surrounding for a period of time Form of generalised seizure - looks like patient may be day dreaming - dysfunction between cortex and thalamus

Question 35

What is the 1st line medication for a patient who is having absence seizures, a form of generalised seizure? 1 - Carbamazepine 2 - Phenytoin 3 - Diazepam 4 - Levetiracetam 5 - Sodium Valproate

Answer 35

5 - Sodium Valproate

Question 36

In all types of generalised seizures do patients lose consciousness?

Answer 36

- yes - can be brief or for prolonger periods

Question 37

In epilepsy seizures can be focal, affecting one specific location such as a lobe or one hemisphere, also called partial seizures of generalised where the the whole brain is affected. In focal / partial seziures they can be simple of complex partial seizures. Which of these does the patient typically remain concious?

Answer 37

- simple partial seizures - patient is typically aware of what is happening and will remember

Question 38

In epilepsy seizures can be focal, affecting one specific location such as a lobe or one hemisphere, also called partial seizures of generalised where the the whole brain is affected. In focal / partial seziures they can be simple of complex partial seizures. In simple partial seizures the patient is generally concious, is aware and will remember what happened. Which of the following typically occur during a simple partial seizures? 1 - strange sensations (smells, tastes etc..) 2 - jerking of muscles 3 - jacksonian march 4 - all of the above

Answer 38

4 - all of the above - jacksonian march = small jerking of muscles spreads to surrounding areas increasing the jerking movements

Question 39

In epilepsy seizures can be focal, affecting one specific location such as a lobe or one hemisphere, also called partial seizures of generalised where the the whole brain is affected. In focal / partial seziures they can be simple of complex partial seizures. In complex partial seizures the patient is generally unconcious. Which of the following typically occur during a complex partial seizures? 1 - loss of consciousness 2 - impaired awareness 3 - memory may be impaired 4 - all of the above

Answer 39

4 - all of the above

Question 40

What is the 1st line medication for a focal (partial) epileptic seizure? 1 - Carbamazepine 2 - Phenytoin 3 - Diazepam 4 - Levetiracetam 5 - Sodium Valproate

Answer 40

1 - Carbamazepine - Levetiracetam and Sodium Valproate could also be given

Question 41

In epilepsy, in animals at least what does the Kindling hypothesis relate to? 1 - decreased seizures results in shorter duration of seizures 2 - increased seizures results in shorter duration of seizures 3 - increased seizures results in longer duration of seizures 4 - decreased seizures results in shorter duration of seizures

Answer 41

3 - increased seizures results in longer duration of seizures - seizure leads to more seizures, this continues until the number of seizures plateaus and the brain burns out - BUT we do not know if this occurs in humans

Question 42

When conducting a history on a patient with suspected epilepsy, which of the following are risk factors that we need to ask about? 1 - family history 2 - duration and number of seizures 3 - medical history (strokes, diabetes) 4 - social history (drugs, alcohol) 5 - all of the above

Answer 42

5 - all of the above

Question 43

The aetiology of epilepsy has a huge list, which can cause provoked (known cause) seizures. Which 4 of the following are the most common causes of provoked seizures in adults? - Antenatal / intrauterine – remote infection, trauma, hypoxia - Genetic - Electrolyte disturbances - Infection - Medications - Drugs - Tumours - Trauma - Congenital disorders - Neurodegenerative conditions - Stroke

Answer 43

- stroke - tumour - trauma - infection

Question 44

The aetiology of epilepsy has a huge list, which can cause provoked (known cause) seizures. Which 4 of the following are the most common causes of provoked seizures in children? - Antenatal / intrauterine – remote infection, trauma, hypoxia - Genetic - Electrolyte disturbances - Infection - Medications - Drugs - Tumours - Trauma - Congenital disorders - Neurodegenerative conditions - Stroke

Answer 44

- genetic - metabolic disorders - trauma - infection

Question 45

What % of epilepsy is accounted for by genetics? 1 - 4% 2 - 20% 3 - 30% 4 - 40%

Answer 45

4 - 40% - associated with multiple rare variants - could also be part of a genetic syndrome, such as tubular sclerosis

Question 46

Monogenic epilepsy is when there is 1 gene that causes epilepsy. This is rare accounting for 1-2% of epilepsy and is transmitted in an autosomal recessive fashion (need a mutated gene from mum and one from dad). What is the most common genetic abnormality cause? 1 - GPCRs mutations 2 - ion channels involved in excitability 3 - ligand gates channels 4 - lack of acetylcholinesterase

Answer 46

2 - ion channels involved in excitability - essentially this causes over activity - called channelopathies

Question 47

Can a genetic diagnosis help with surgery?

Answer 47

- yes - if we know there is a genetic cause, surgery would be high risk and pointless - we can also tailor medication

Question 48

Once a patient has had a seizure, typically how quickly should they be seen by a neurologist? 1 - immediately 2 - <24h 3 - <1 week 4 - <2 weeks

Answer 48

4 - <2 weeks

Question 49

If a patient has an acute seizure and epilepsy is suspected, what are the 3 most basic tests a patient may undergo to try and diagnose why they had the seizure (before doing an EEG)? 1 - blood test, imaging, lumbar puncture 2 - blood test, cranial nerve examination, imaging 3 - blood test, cranial nerve examination, history 4 - imaging, cranial nerve examination, imaging

Answer 49

1 - blood test, imaging, lumbar puncture - blood tests (infection, blood glucose) - lumbar puncture (rule out infection) - imaging (rule out stroke/tumour) ECG should also be performed to rule out cardiac problems such as prolonged QT-interval

Question 50

Seizures in epilepsy can be provoked or unprovoked. 1 - Provoked immediate (known cause) - toxin, medication, metabolic - recurrence is low in the absence of the provoking factor - acute symptomatic (close to the time of a brain insult) - recurrence is 80% less likely than a remote symptomatic seizure 2 - Unprovoked (no known cause) - remote symptomatic (pre-existing brain injury) - associated with an epileptic syndrome Why is it important to identify if the seizure is provoked or unprovoked?

Answer 50

- if we can identify a cause (provoked) we can treat this - important for prognosis and treatment

Question 51

Seizures are common in epilepsy, but it is important to differentiate if this is an epileptic seizure or not. Which of the following would NOT be considered in a differential for epilepsy? epileptic seizure = abnormal firing in brain non-epileptic seizure = no abnormal firing in brain 1 - non-epileptic 2 - syncope (can have twitches) 3 - sleep attack 4 - cataplexy (loss of muscle tone) 5 - migraine 6 - transient ischaemic attack 7 - stroke

Answer 51

7 - stroke

Question 52

If a patient has non-epileptic seizures what is the mainstay of treatment? epileptic seizure = abnormal firing in brain non-epileptic seizure = no abnormal firing in brain 1 - medication 2 - electroconvulsive therapy 3 - psychotherapy 4 - surgery

Answer 52

3 - psychotherapy - 10-15% of patients with epilepsy can have non-epileptic attacks

Question 53

It is important to be able to differentiate between epileptic and non-epileptic seizures. What is the key difference between epileptic and non-epileptic seizures? epileptic seizure = abnormal firing in brain non-epileptic seizure = no abnormal firing in brain 1 - if electrical activity in the brain is dysfunctional 2 - age of the patient 3 - duration of symptoms 4 - all of the above

Answer 53

1 - if electrical activity in the brain is dysfunctional Non-epileptic seizures can be caused by: - Fever - Infection - Electrolyte imbalance - Withdrawal from drugs or alcohol - Extremely low blood sugar - Brain damage from stroke, brain surgery, or head injury

Question 54

In an epileptic seizure are the eyes typically open?

Answer 54

- yes - if patients eyes are closed and resistant to opening, likely this is a non-epileptic seizure epileptic seizure = abnormal firing in brain non-epileptic seizure = no abnormal firing in brain

Question 55

Which of the following are characteristics of a non-epileptic seizure? epileptic seizure = abnormal firing in brain non-epileptic seizure = no abnormal firing in brain 1 - 2/3 have prominent motor features  2 - there is a gradual onset that wax and wane lasting over 2 minutes  3 - patient is motionless unresponsiveness for over 5 minutes following the non-epileptic seizure 4 - patient may not respond to drugs 5 - all of the above

Answer 55

5 - all of the above

Question 56

The babinski sign is used to asses neurological dysfunction. - negative babinski in >2 y/o all toes curl - negative babinski in <2/yo big toe curls up and other 4 toes curl down - positive babinski in >2/yo big toe curls up and other 4 toes curl down Do patients with a tonic-clonic epileptic seizure and non-epileptic seizures have a positive babinski sign?

Answer 56

- no - tonic-clonic epileptic seizure = positive Babinski - non-epileptic seizures = negative Babinski

Question 57

When trying to distinguish between a tonic-clonic epileptic seizure and non-epileptic seizures, which have no corneal reflexes? epileptic seizure = abnormal firing in brain non-epileptic seizure = no abnormal firing in brain

Answer 57

- tonic-clonic epileptic seizure = no corneal reflex - non-epileptic seizures = have corneal reflex as the neuronal activity in the brian is not affected

Question 58

Do patients with a non-epileptic seizures have changes on an EEG? epileptic seizure = abnormal firing in brain non-epileptic seizure = no abnormal firing in brain

Answer 58

- no as there is typically no abnormal neuronal activity - there will be muscle artefacts

Question 59

What is a convulsive seizure? 1 - patient faints and then shakes 2 - patient has seizure and remains unconscious 3 - patient has abnormal brain activity that causes autonomic abnormality 4 - all of the above

Answer 59

1 - patient faints and then shakes - can be caused by cerebral hypoxia causing myoclonal jerks - common referral to neurologist

Question 60

Which of the following is NOT one of the 3 steps to classify epilepsy? 1 - classify type of seizure (focal/partial vs generalised) 2 - classify type of epilepsy (provoked or seizure) 3 - duration of seizure 4 - diagnosis of epilepsy syndrome

Answer 60

3 - duration of seizure - important in history taking, but not for classification

Question 61

Which of the following is the best time to conduct an EEG? 1 - Prodrome 2 - Preictal/aura 3 - Ictal 4 - Post-ictal

Answer 61

3 - Ictal - essentially during the seizure - EEG lasts 30-40 minutes, read at 10 second intervals

Question 62

To look at a patients seizures in real time, what technique can be used, and what part of the brain is monitored? 1 - ECG and cerebral cortex 2 - ECG and brain stem 3 - EEG and cerebral cortex 4 - EEG and brain stem

Answer 62

3 - EEG and cerebral cortex - cerebral cortex as this is closest to monitors - EEG lasts 30-40 minutes, read at 10 second intervals

Question 63

When considering different rhythms on an EEG, which 2 of the following would only be present during sleep? 1 - alpha 2 - beta 3 - theta 4 - delta

Answer 63

3 - theta 4 - delta - alpha and beta are only present when awake

Question 64

Does a normal EEG rule out epilepsy?

Answer 64

- no, seizure could have passed and brain has returned to normal - depends on when the seizure was and soon EEG can be done following the seizure

Question 65

Epileptiform discharges are used to identify if a patient has epilepsy. What are epileptiform discharges? 1 - abnormal signals on an ECG characterised by large spike waves 2 - abnormal signals on an EEG characterised by large spike waves

Answer 65

2 - abnormal signals on an EEG characterised by large spike waves

Question 66

If a seizure is no longer happening, can epileptiform discharges still be detected to help diagnosis epilepsy?

Answer 66

- yes, providing close to time of seizure otherwise neuronal activity returns to normal - called interictal (in between seizures) epileptiform discharges (IED)

Question 67

When trying to measure epileptiform discharges on an EEG to help diagnosis epilepsy, why is it important to ask about medication?

Answer 67

- medication can affect action potentials and therefore the EEG trace - benzodiazepine can inhibit neuronal activity through GABA

Question 68

What is the only time an EEG rule out epilepsy? 1 - when we know the cause and precipitating factor 2 - when we know the full medical history and medication of the patient 3 - <30 minutes from a seizure occurring 4 - when a seizure is occurring

Answer 68

4 - when a seizure is occurring - if epileptiform discharges are not present (uncommon EEG patterns characterised by lateralised or generalised; periodic or near periodic; or spike, spike-wave, or sharp-wave complex presentations throughout most or all of the recording) then epilepsy is unlikely the cause of the seizure

Question 69

EEGs are not great at detecting epileptiform discharges. Therefore, clinicians can ask patients to do certain things in an attempt to induce a seizure. Which of the following is NOT a common methods of doing this? 1 - sleep deprivation 2 - hyperventialtion 3 - alcohol consumption 4 - photic stimulation 5 - medication withdrawal

Answer 69

3 - alcohol consumption - can increase risk of seizures, but not used clinically

Question 70

Interictal epileptiform discharges (IEDs), meaning uncommon spikes, polyspikes, sharp waves, or spike and slow-wave complexes in between seizures are commonly observed in children with epilepsy. However, they can also be detected in 0.5% of adults and 2-6% of children who are healthy. Is this important?

Answer 70

- Yes - important to ensure diagnosis is correct

Question 71

Patients can have multiple seizures within a 24 hour window, but this does not increase the risk of re-occurrence of seizures. What does increase the risk of re-occurrence in unprovoked (unknown cause) seizures? 1 - when seizure re-occurrence occurs in first 6 months 2 - when seizure re-occurrence occurs in first year 3 - when seizure re-occurrence occurs in first 2 years 4 - when seizure re-occurrence occurs in first 5 years

Answer 71

3 - when seizure re-occurrence occurs in first 2 years - 21-45% occur within first 2 years - higher if there are epileptiform discharges on EEG

Question 72

When a patient has a seizure, what should patients be told about their lifestyle changes in an attempt to reduce seizures occurring again? 1 - take medication regularly 2 - lose weight, avoid lack of sleep, reduce alcohol 3 - avoid lack of sleep, reduce alcohol and reduce risk of infections 4 - gain weight, avoid lack of sleep, reduce alcohol

Answer 72

3 - avoid lack of sleep, reduce alcohol and reduce risk of infections

Question 73

Why is it important to ensure patients at risk of seizures do not do the following: - unsupervised activities - bathing, swimming, working at heights, operating heavy machinery - driving

Answer 73

- pose a risk to the individual and others

Question 74

Patients who have epilepsy are more susceptible to neuropsychiatric co-morbidities. Which of the following are they are increased risk of developing? 1 - depression 2 - anxiety 3 - suicide risk 4 - psychosis 5 - all of the above

Answer 74

5 - all of the above

Question 75

What does inter-ictally (latin for blow or stroke) mean in relation to epilepsy? 1 - occurring between seizures 2 - occurring before seizures 3 - occurring after seizures

Answer 75

1 - occurring between seizures

Question 76

In patients post-ictally, following a seizure, they typically experience all of the following EXCEPT which one? 1 - headahces 2 - confusion 3 - weight loss 4 - myalgia 5 - temporary weakness

Answer 76

3 - weight loss

Question 77

What is sudden unexplained death of epilepsy (SUDEP)?

Answer 77

- unexplained death in epilepsy, but is rare - 2-18% incidence (higher in children) - more severe epilepsy are a higher risk

Question 78

In a focal / partial complex or simple seizures (affecting part of the brain), which of the following medications is the 1st line? 1 - Diazepam 2 - Carbamazepine 3 - Clozapine 4 - Amitriptyline

Answer 78

2 - Carbamazepine - anti-epiletptic medication - 2nd line from out medication list is sodium valprolate

Question 79

In all forms of generalised seizure (affecting both sides of the hemisphere), which of the following medications is the 1st line? 1 - Diazepam 2 - Carbamazepine 3 - Clozapine 4 - Sodium Valprolate

Answer 79

4 - Sodium Valprolate - mood stabiliser medication - second line medication is Carbamazepine an anti-epiletptic medication

Question 80

Which of the 3 core drugs Diazepam, Carbamazepine and Phenytoin have been shown to have adverse events in asian populations? 1 - Diazepam 2 - Carbamazepine 3 - Phenytoin

Answer 80

2 - carbamazepine - asians (Chinese) are higher risk due to genetic risk

Question 81

Is epilepsy permanent?

Answer 81

- no - patients can be remission - normally if a patient does not have a seizure within 1 year

Question 82

Patients can slowly be titrated off their epileptic medication if they are seizure free for how long? 1 - >6 months 2 - >1 year 3 - >2 years 4 - >4 years

Answer 82

3 - >2 years - can also drive

Question 83

There are different things that can occur in seizures. Which of the following is the definition of Ictal? 1 - drowsy, confused, psychotic. Bitten tongue, lost continence 2 - feeling, sensations, changes in behaviour hours or days before the event 3 - actual event (may need witness description) 4 - immediately prior (not always present)

Answer 83

3 - actual event (may need witness description)

Question 84

When trying to image a patient with epilepsy, which 2 of the following contrasts are used? 1 - Tc-99m-ECD: Ethyl Cysteinate Dimer 2 - Tc-99m-HMPAO: Hexa methyl propyl amine oxime 3 - fluorine-18-fluorodeoxyglucose (F-FDG)

Answer 84

1 - Tc-99m-ECD: Ethyl Cysteinate Dimer 2 - Tc-99m-HMPAO: Hexa methyl propyl amine oxime

Question 85

Which of the following do seizures NOT typically occur in? 1 - intracerebral bleed 2 - herpes simplex encephalitis 3 - venous sinus thrombosis 4 - acute stroke

Answer 85

4 - acute stroke - can occur, but it is rare

Question 86

What is the 1st line imaging in a seizure? 1 - CT 2 - MRI 3 - PET-CT 4 - ultrasound

Answer 86

1 - CT - accessible, less contraindications and performed faster than MRI Can also rule out other causes of seizures MRI should be performed in <2 y/o with suspected epilepsy

Question 87

Which 2 of the following can be used to assess functional imaging in a child who is suspected of having epilepsy? 1 - PET 2 - SPECT / Ictal SPECT 3 - contrast CT 4 - X-ray

Answer 87

1 - PET 2 - SPECT / Ictal SPECT PET = Positron emission tomography SPECT = Single-photon emission computed tomography Useful for identifying increased metabolic demand and identify specific regions of the brain, that may help if surgery is an option

Question 88

What is grey matter heterotopia? 1 - lack of grey matter 2 - grey matter being too small to function 3 - grey matter located in atypical locations 4 - all of the above - grey matter = neurons - white matter = communication pathways

Answer 88

3 - grey matter located in atypical locations - common in epilepsy

Question 89

What is grey matter schizencephaly, which is common in epilepsy? 1 - lack of grey matter 2 - grey matter being too small to function 3 - grey matter located in atypical locations 4 - abnormal clefts in the grey matter - grey matter = neurons - white matter = communication pathways

Answer 89

4 - abnormal clefts in the grey matter

Question 90

What is focal cortical dysplasia? 1 - neurons in an area of the brain failed to migrate in the proper formation in utero 2 - grey matter being too small to function 3 - grey matter located in atypical locations 4 - abnormal clefts in the grey matter - grey matter = neurons - white matter = communication pathways

Answer 90

1 - neurons in an area of the brain failed to migrate in the proper formation in utero - common in epilepsy

Question 91

What is leukodystrophies? 1 - neurons in an area of the brain failed to migrate in the proper formation in utero 2 - abnormal degeneration of white matter in the brain 3 - grey matter located in atypical locations 4 - abnormal clefts in the grey matter - grey matter = neurons - white matter = communication pathways

Answer 91

2 - abnormal degeneration of white matter in the brain - rare inherited disorder

Question 92

What is tuberose sclerosis? 1 - neurons in an area of the brain failed to migrate in the proper formation in utero 2 - abnormal degeneration of white matter in the brain 3 - grey matter located in atypical locations 4 - benign tumours that form in the brain - grey matter = neurons - white matter = communication pathways

Answer 92

4 - benign tumours that form in the brain - can cause epileptic seizures

Question 93

In the image below, which of the following types of bleeds is this: - subdural = below dural matter and above the arachnoid membrane - epidural (also called extradural) = between skull and dura matter - subarachnoid = space surrounding the brain

Answer 93

- subdural = below dural matter and above the arachnoid membrane - think concave/crescent shape - suB = Banana appearance

Question 94

In the image below, which of the following types of bleeds is this: - subdural = below dural matter and above the arachnoid membrane - epidural (also called extradural) = between skull and dura matter - subarachnoid = space surrounding the brain

Answer 94

- epidural (also called extradural) = between skull and dura matter - think convex/lens shaped - Epi Pie = Epidural

Question 95

In the image below, which of the following types of bleeds is this: - subdural = below dural matter and above the arachnoid membrane - epidural (also called extradural) = between skull and dura matter - subarachnoid = space surrounding the brain

Answer 95

- subarachnoid = space surrounding the brain - blood appears darker than the grey matter - these bleeds are able to bleed into the sulcus