Epilepsy

Question 2

Etiology of Seizures

Answer 2

Question 3

Criteria of Dx of Epilepsy

Answer 3

Question 4

Classification of Seizures

Answer 4

Question 5

Types of Focal Seizures

Answer 5

Question 6

Types of Generalized Seizures

Answer 6

1. Generalized Tonic-Clonic Seizures
2. Absence Seizures
3. Myoclonic Seizures
4. Tonic Seizures
5. Atonic Seizures

Question 7

CP of Focal Aware Motor Seizures (Simple Partial)

Answer 7

Question 8

CP of Focal Impaired Awareness Seizures (Comple Partial)

Answer 8

Question 9

CP of Generalized Motor (Tonic-Clonic) Seizures “GTCS”

Answer 9

• No preceding Aura or warning
• Ictal Stages
• Post-Ictal Stages

Question 10

CP of Generalized Motor (Tonic-Clonic) Seizures “GTCS”

• Aura

Answer 10

No preceding Aura or warning

Question 11

CP of Generalized Motor (Tonic-Clonic) Seizures “GTCS”

• Ictal Stage

Answer 11

Question 12

CP of Generalized Motor (Tonic-Clonic) Seizures “GTCS”

• Tonic Phase of Ictal Stage

Question 13

CP of Generalized Motor (Tonic-Clonic) Seizures “GTCS”

• Clonic Phase of Ictal Stage

Answer 13

Question 14

CP of Generalized Motor (Tonic-Clonic) Seizures “GTCS”

• Post-Ictal Stage

Answer 14

Question 15

CP of Generalized Non-Motor (Absence) Seizures

Answer 15

Question 16

DDx of Seizures

Answer 16

Question 17

Characters of (Pseudo-seizures)

Answer 17

Question 18

Dx of Seizures

Question 19

Dx of Seizures

• Hx & Ex

Answer 19

Question 20

Dx of Seizures

• Labs

Answer 20

Question 21

Dx of Seizures

• Neuroimaging

Answer 21

Question 22

Dx of Seizures

• EEG

Question 23

Significance of EEG

Answer 23

• Differentiate epileptic seizures from conditions that mimic them.
• Classify seizure types
• Tailor therapy.

Question 24

The yield of EEG increases with ……

Answer 24

• Sleep deprivation
• Performing multiple studies
• Performing the study in close proximity to the seizure.

Question 25

TTT of **Seizures**

Question 26

TTT of **Seizures** - TTT of Provoked Seizures

Answer 26

Question 27

TTT of **Seizures** - TTT of Unprovoked Seizures & Epilepsy

Answer 27

Question 28

ASMs may be prescribed for patients after a first unprovoked seizure if there is:

Answer 28

Question 29

TTT of **Seizures** - General Principles in drug therapy

Answer 29

Question 30

The choice of ASM is usually based on:

Answer 30

Question 31

Examples of **ASM**

Answer 31

Question 32

Drug of Choice - Focal seizures and secondarily Generalized seizures

Answer 32

Phenytoin, Carbamazepine, Oxcarbazepine, Levetiracetam, Lamotrigine

Question 33

Drug of Choice - Primary generalized tonic-clonic seizures

Answer 33

Valproate, Lamotrigine

Question 34

Drug of Choice - Abxence Seizures

Answer 34

Valproate, Ethosuximide

Question 35

Drug of Choice - Juvenile myoclonic epilepsy

Answer 35

Valproate, Levetiracetam

Question 36

Drug of Choice - Patient taking multiple medications

Answer 36

Levetiracetam, Lacosamide

Question 37

Drug of Choice - Medication expense is a concern

Answer 37

Phenytoin, Carbamazepine, Valproate

Question 38

Drug of Choice - Pregnancy

Answer 38

Lamotrigine, Levetiracetam (avoid valproate)

Question 39

Drug of Choice - Hepatic Failure

Answer 39

Levetiracetam, Topiramate, Gabapentin

Question 40

Drug of Choice - Renal Failure

Answer 40

Carbamazipine, Oxcarbazepine, Lamorigine

Question 41

Withdrawing ASMs

Answer 41

Question 42

Ideal candidates for medication withdrawal have:

Answer 42

Question 43

TTT of **Status Epilepticus**

Question 44

TTT of **Status Epilepticus** - Life Support

Answer 44

Question 45

TTT of **Status Epilepticus** - Abort Seizures

Answer 45

Question 46

TTT of **Status Epilepticus** - Abort Seizures (Phase I)

Answer 46

Intravenous lorazepam (0.1 mg/kg) or diazepam (0.15 mg/kg)

Question 47

TTT of **Status Epilepticus** - Abort Seizures (Phase II)

Answer 47

- Intravenous phenytoin (15-20 mg/kg) - Valproate (25-40 mg/kg) or Levetiracetam (1000- 3000 mg)

Question 48

TTT of **Status Epilepticus** - Abort Seizures (Phase III)

Answer 48

Question 49

TTT of **Status Epilepticus** - Abort Seizures (Phase IV)

Answer 49

- Pentobarbital is loaded at a dose of 5 mg/ kg followed by IV infusion of 1-10 mg/kg/hr, titrated gradually upwards to a burst- suppression pattern on EEG

Question 50

TTT of **Status Epilepticus** - Determine the etiology

Answer 50

- Once seizure control is established, focus on determining the etiology - History, examination, Laboratory studies, Neuroimaging and sometimes CSF examination.

Question 51

TTT of **Status Epilepticus** - Prevent Further Episodes

Answer 51

- Correct the proximate cause of status epilepticus if detected. - Patients with known epilepsy need ASM regimen modification to prevent seizure recurrence.