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Adams Principles of Neurology > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

A group of somewhat diverse, age-dependent phenotypes that are characterised by generalized 2.5-4 Hz bifrontally predominant spikes or polyspike-and-slow-wave discharges that arise without underlying structural abnormalities.

A

Primary Generalized Epilepsy

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2
Q

Clinical states that simulate generalized tonic-clonic seizure

A

psychogenic episodes, vasodepressor syncope, basilar artery occlusion, fainting lark

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3
Q

Absence seizures are said to be “typical” if they have the following characteristics?

A

rapid onset and offset, typical three per second spike and wave, complete loss of awareness

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4
Q

This is the most common form of idiopathic generalized epilepsy in older children and young adults

A

Juvenile Myoclonic Epilepsy

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5
Q

Somatosensory seizures

A

postcentral convolution of the parietal lobe

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6
Q

Olfactory hallucinations

A

parahippocampal convolution of the uncus

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7
Q

Visual seizures

A

striate cortex of the occipital lobe

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8
Q

Auditory hallucinations

A

superior temporal convolution

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9
Q

vertiginous sensations

A

superoposterior temporal region

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10
Q

visceral sensations

A

middle frontal gyrus

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11
Q

Common manifestations of frontal lobe epilepsy

A

volvular epilepsy or walking repetitively in small circles, epilepsia procursiva or running and poriomania or wandering aimlessly

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12
Q

Most common type of reflex epilepsy

A

Visual

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13
Q

Beneficial treatment of choice in Rasmussen Syndrome

A

high dose corticosteroid

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14
Q

AEDs that can greatly increase the chance of breakthrough menstrual bleeding in women taking oral contraceptives

A

Phenytoin, Carbamazepine, Barbiturates

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15
Q

AEDs associated with lower IQ in children

A

Sodium Valproate, Phenytoin, Carbamazepine

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16
Q

If a woman with seizure disorder has been off epilepsy medications for a time before getting pregnant and seizes during pregnancy, what is the best choice of AED?

A

Phenytoin, Levetiracetam

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17
Q

Most frequent idosyncratic reaction to AEDs

A

Rash

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18
Q

Sequence of life-threatening events encountered in cases of convulsive status epilepticus

A

Rising temperature –> Acidosis –> Hypotension –> Renal Failure

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19
Q

Approximately how many % of all patients with epilepsy are candidates for surgical therapy?

A

25%

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20
Q

Major source of caloric intake in epileptic patients initiated on ketogenic diet

A

80-90% Fats

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21
Q

2014 ILAE new definition for epilepsy

A

A disease with either recurrent unprovoked seizures occurring at least 24 hours apart or a heightened tendency of at least 60% toward recurrent unprovoked seizures, or when an epilepsy syndrome in diagnosed.

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22
Q

Most common non-neurologic disorder mimicking epilepsy

A

Syncope

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23
Q

MRI sequence which have shown 97% accuracy for detecting abnormalities associated with medial temporal sclerosis

A

FLAIR imaging sequence

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24
Q

The only condition with evidence supporting AED prophylaxis

A

high-risk head injury in the early post traumatic period

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25
Responsible for most of the metabolism of Phenytoin
CYP2C9
26
Responsible for most of the metabolism of Carbamazepine
CYP3A4
27
AED with multiple mechanisms of action including GABA potentiation, blocking of T-type calcium channels and blocking sodium channels
Valproate
28
Drug-resistant epilepsy is defined as a failure of adequate trials of ____ tolerated, appropriately chosen and used anticonvulsant drug schedules to achieve sustained seizure freedom.
two
29
It constitutes the most characteristic epilepsy of childhood
Typical absence seizures
30
T/F: The typical absence, with or without myoclonic jerks, rarely cause the patient to fall.
True
31
T/F: The generalized tonic-clonic seizures of Juvenile Myoclonic Epilepsy occurs upon awakening.
True
32
A particular combination of gelastic seizures and precocious puberty has been traced to this condition?
Hamartoma of the hypothalamus
33
This common focal motor epilepsy is unique among the focal epilepsies of childhood in that it is self-limiting despite of very abnormal EEG pattern
Rolandic Epilepsy
34
One of the most common viral precipitants of febrile seizures
Herpesvirus 6
35
T/F: Blood for serum levels is ideally drawn in the morning before breakfast before the first ingestion of anticonvulsant
True (through levels)
36
T/F: In general, higher serum concentrations of drug are necessary for the control of focal seizures than for generalized ones.
True
37
T/F: The patient remains apneic until the end of the clonic phase.
True
38
T/F: It is useful to know that seizures on awakening usually signify a generalized type, whereas those occurring during the period of sleep are more often focal in nature.
True
39
It constitutes the most characteristic epilepsy of childhood.
Typical absence seizures
40
T/F: Akinesia or motionlessness is not unique to any seizure type
True
41
T/F: Seizure-associated myoclonus, when occurring in isolation, is relatively benign and usually responds well to medication.
True
42
Most common form of idiopathic generalized epilepsy in older children and young adults.
Juvenile Myoclonic Epilepsy
43
Most common origin of focal motor seizures
Supplementary motor area
44
T/F: Todd's paralysis usually persists in proportion to the duration of the convulsion.
True
45
Most frequently reported color in visual seizures.
Red
46
Localization of vertiginous seizures
Superoposterior temporal region
47
T/F: EEG recording during sleep is particularly helpful because of focal abnormalities in the temporal lobes in slow-wave and stage II sleep.
True
48
These AEDs can greatly increase the chance of breakthrough menstrual bleeding in women taking oral contraceptives.
Phenytoin, Carbamazepine, barbiturates
49
If a woman with seizure disorder has been off epilepsy medications for a time before getting pregnant and seizes during pregnancy, what is the best choice of medication?
Phenytoin, Levetiracetam
50
Most frequent idiosyncratic reactions to the drugs used to treat epilepsy
Rashes
51
Approximately how many % of all patients with epilepsy are candidates for surgical therapy?
25%
52
Gene associated with Juvenile Myoclonic Epilepsy
GABRA1 (CACNB4)
53
The most frequent cause of convulsions due to metallic poisoning in children
Lead (Mercury in both adults and children)
54
T/F: Drug resistant epilepsy is defined as failure of adequate trials of 3 tolerated and appropriately chosen aED schedules.
False (2)
55
Most common teratogenic effects of AEDs
Cleft lip and palate
56
AED which may precipitate Absence and Myoclonic Seizures
Carbamazepine (also Phenytoin in LGS)
57
Paroxysmal depolarizing shifts
Partial epilepsy
58
Paroxysmal depolarizing shift is most likely the underlying mechanism of which seizure type?
Complex partial seizure
59
In about 50% of patients with infantile spasms, seizures are replaced by this type of syndrome?
Lennox-gastaut syndrome
60
Perception of unfamiliarity with previously familiar people.
Deja entendu
61
Also called early infantile epileptic encephalopathy with suppression bursts
Ohtahara syndrome
62
Mimic infantile spasm by semiology but with normal EEG
Benign myoclonus of infancy
63
Refers to acquired epileptic aphasia in children
Landau-Kleffner syndrome
64
Antibodies implicated in the pathogenesis of Rasmussen's encephalitis.
GLUR3 antbodies
65
Occurs with intravenous administration of phenytoin causing severe tissue injury from the constriction of blood vessels.
Purple glove syndrome
66
T/F: Gabapentin is absorbed in a dose-dependent fashion so that a smaller proportion is absorbed at higher doses.
True
67
What is the difference of Lamotrigine from Phenytoin and Carbamazepine in terms of mechanism of action?
It also inhibits glutamate release (aside fron inhibiting Na channels like phenytoin and CBZ)
68
AED contraindicated if with sulfonamide allergy
Zonisamide
69
AED banned in the US because of 30% risk of irreversible visual field constriction
Vigabatrin
70
T/F: estrogen has proconvulsant effects and progesterone has anticonvulsant effects
True
71
Caused by mutation in the voltage-gated potassium channel KCNQ2 gene on chromosome 20
Benign familial neonatal convulsions
72
An early nonforced head turn localizes to
Ipsilateral temporal lobe
73
Triad of hypotension, lipidemia and metabolic acidosis
Propofol infusion syndrome
74
The phenytoin dosage should be increased each time by only this amount
25-30 mg in adults
75
T/F: Phenytoin has an affinity for thyroid-binding globulin which confuses some test of thyroid function
True
76
Most common dose-related adverse effects requiring dosage adjustment in phenytoin
Doplopia and ataxia
77
This AED enhances slow inactivation of voltage-gated Na+ channels
Lacosamide (in contrast to prolongation of fast inactivation shown by other AEDs)
78
Idiosyncratic toxicity of Valproate
Hepatotoxicity
79
T/F: at 0.5 minimal alveolar concentration (MAC), the reduction in CMR is greater than the vasodilation caused by the anesthetic so the cerebral blood flow is decreased.
True
80
T/F: Although Propofol leads to general suppression of CNS activity, excitatory effects such as twitching or spontaneous movement are occasionally observed during induction of anesthesia.
True
81
Selective antagonist of benzodiazepine
Flumazenil
82
T/F: phenytoin exhibit capacity-limited elimination.
True
83
Antiepileptic drug with similar properties as tricyclic antidepressants.
Carbamazepine
84
AED that worsen Absence and JME
Phenytoin, Carbamazepine
85
AED not affected by enzyme inducers and inhibitors
Levetiracetam, Gabapentin
86
AED that can potentially lead to renal stone formation
Zonisamide, Topiramate
87
AED associated with weight loss
Zonisamide, Topiramate
88
Treatment of choice for absence with tonic-clonic seizures
Valproate
89
First-line broad spectrum antiseizure drug
Valproate

Adams Principles of Neurology (19 decks)

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