Epilepsy Flashcards
1
Q
Gelastic seizures + precocious puberty
A
Hamartoma of the hypothalamus
2
Q
The condition that presents with jacknife seizures w/ hypsarrhythmia is responsive to…
A
ACTH, corticosteroids, benzos
If 2/2 TS, vigabatrin
3
Q
West Syndrome can progress to..
A
Lennox-Gastaut Syndrome
4
Q
Main (3) features of Typical Absence
A
Typical 3/s spike & wave
Rapid onset and offset
Complete loss of awareness
5
Q
Atonic, astatic seizures (falling attacks)
Minor motor t-c and partial seizures
Progressive intellectual impairment
Onset: 2-6 yo
EEG Slow 1-2 Hz spike and wave
A
Lennox-Gastaut Syndrome
6
Q
Most common form of idiopathic generalized epilepsy in older children and young adults
A
Juvenile Myoclonic Epilepsy
7
Q
Masticatory, salivation, speech arrest
A
Amygdaloid nuclei, opercular
8
Q
Head & eye turning a/w arm movement, athetoid-dystonic postures
A
Supplementary motor cortex
9
Q
Vertiginous
A
Superior temporal
10
Q
Olfactory
A
Mesial temporal
11
Q
Gustatory
A
Insula
12
Q
Visceral:autonomic
A
Insular-orbital-frontal cortex
13
Q
Automatism
A
Temporal and frontal
14
Q
Head turning ipsilaterally, then contraversive turning
A
Temporal lobe
15
Q
Fencing posture
A
SMC, High medial frontal
16
Q
Most frequently reported color (visual sz)
A
Red
17
Q
Palpitation, tachycardia at the beginning of the attack
A
Temporal
18
Q
Psychomotor triad of temporal lobe seizures
A
- Motor changes
- Automatic behavior
- Alterations in psychic function
19
Q
1) Prolonged disorientation for time and place suggests a ____(left/right)-sided source
2) Post ictal nose wiping carried out by hand ______ (ipsi/contra) to the seizure focus
A
1) Prolonged d/o to time & place: RIGHT-sided
2) Post-ictal nose wiping: IPSILATERAL to the sz focus
20
Q
Triad of behavioral abnormalities for pts w/ temporal lobe origin
A
- HYPOsexuality
- HYPERgraphia
- HYPERreligiosity
21
Q
EEG finding in pts w/ jacknife seizures
A
(Jacknife seizures / infantile spasms: West Syndrome)
EEG: Hypsarrhythmia (mountainous dysrhythmia)
22
Q
Treatment for West Syndrome
- and those w/ TS
A
ACTH, corticosteroids, benzodiazepines
Vigabatrin for those w/ Tuberous Sclerosis!
23
Q
Common virus associated w/ Febrile Seizures
A
Herpesvirus 6
24
Q
Rasmussen Syndrome has antibodies against:
A
GluR3 (glutamate receptors)
25
What is kindling?
Special mechanism that creates a secondary sz focus
Repeated stimulation w/ subconvulsive electrical pulses from a focus elsewhere
26
Most common associated histologic finding in Mesial Temporal Sclerosis
Loss of neurons in the CA1 segment (Sommer sector)
Pyramidal layer, hippocampus
27
Give the involved
1) Channel
2) Gene
3) Protein
Familial generalized sz w/ febrile sz plus
1) Sodium channel
2) SCN1A,B (GABAa)
3) Na channel subunits > GABA receptor
28
Give the involved
1) Channel
2) Gene
3) Protein
Dravet Syndrome
1) Sodium channel
2) SCN1A
3) Sodium channel a-subunit
29
Give the involved
1) Channel
2) Gene
3) Protein
Episodic ataxia type 1 w/ partial epilepsy
1) Potassium channel
2) KCNA1
3) K channel subunits
30
Give the involved
1) Channel
2) Gene
3) Protein
Episodic ataxia type 2 w/ spike-wave sz
1) Ca channel
2) CACNA1A
3) Ca channel subunit
31
Give the involved
1) Channel
2) Gene
3) Protein
Juvenile Myoclonic Epilepsy
1) Ligand-gated channel
2) GABRA1 (CACNB4)
3) GABAa receptor subunit > Ca subunit
32
Give the involved
1) Pathology
2) Gene
3) Protein
Fukuyama muscular dystrophy, lissencephaly, generalized epilepsy
1) Malformations of Cortical development
2) FCMD
3) Fukutin
33
Give the involved
1) Pathology
2) Gene
3) Protein
Angelman syndrome
1) Malformations of cortical development
2) UBE3A
3) Ubiquitin-protein ligase
34
Give the involved
1) Gene
2) Protein
Lafora body disease w/ PME
EPM2A
Laforin, protein tyrosine phosphatase
35
Give the involved
1) Gene
2) Protein
Autosomal dominant lateral temporal lobe epilepsy
LGI1
Leucine-rich glioma inactivated protein
36
Most common lesions underlying status epilepticus in late adult life
Previous infarcts
37
Which among the ff antibiotics that cause sz can result in status epilepticus
A. Imipinem
B. Penicillin
C. Cefepime
D. Linezolid
C.
“Cefepime can result in SE”
38
What do you call the chronic intention myoclonus state pos HIE?
Lance-Adams Syndrome
39
```
Which of the following is NOT safe for breastfeeding mothers:
A. Phenobarbital
B. Valproate
C. Phenytoin
D. Carbamazepine
```
Ans: Phenobarbital (NOT SAFE for breastfeeding - high concentration)
Carbamazepine, Phenytoin, Valproate have low concentrations. SAFE
40
Characteristic of anticonvulsant exposure
Mid-face hypoplasia
41
Effect of
1) Phenytoin
2) Phenobarbital/Carbamazepine
On Warfarin:
Phenytoin INCREASES warfarin levels
Phenobarbital/Carbamazepine DECREASE warfarin levels
"phengy pa ng warfarin"
"phenobaba ang levels"
42
Which AEDs (2) have effects on T-type Ca channel inhibition?
Ethosuximide
| Valproic Acid
43
Which AED does NOT cause weight LOSS?
A. Valproic Acid
B. Topiramate
C. Zonisamide
A. Valproic Acid
- causes weight GAIN
Topiramate and Zonisamide cause weight loss (and nephrolithiasis!!)
44
What is the notable side effect of Vigabatrin?
Retinal toxicity
45
What is the MOA of Levetiracetam?
SV2A modulation
46
Which among the following is NOT a Na Channel inhibitor?
A. Phenytoin
B. Phenobarbital
C. Lamotrigine
D. Carbamazepine
B. Phenobarbital - GABA potentiation
```
Na Channel:
Carbamazepine, Oxcarbazepine
Phenytoin
Lacosamide
Lamotrigine
Valproic Acid
Topiramate
```
47
Which among Valproic Acid and Topiramate have NMDA inhibition?
Valproic Acid.
Both have:
1. GABA potentiation
2. Na channel inhibition
VA: NMDA, T-type Ca channel inhibition
Topi: AMPA (TAMPA), Ca channel inhibition
48
Initial choice of AED for absence seizures:
Valproate
49
Initial choice of AED for Focal seizures (2)
Carbamazepine, phenytoin
50
Initial choice of AED for Infantile Spasms
ACTH, Vigabatrin
51
Initial choice of AED for Lennox-Gastaut
Valproate
52
Which AED has “autoinduction”
Carbamazepine
53
Which AED causes duyputren contractures?
Phenobarbital
PhBaDuy
54
Which gene is mutated in Dravet Syndrome?
SCN1A
55
In which age group can the first seizure most likely take the form of status epilepticus?
Early childhood
56
Which AEDs have high concentrations in breast milk?
Phenobarbital
Benzodiazepines
Ethosuximide, Zonisamide, Primidone
PhenoBarest milk
Bezp milk
57
Which AEDs have low concentrations in breast milk?
Phenytoin
Carbamazepine
Valproate
Pheny Can Vouch for these meds
58
Most common teratogenic effect of AEDs
Cleft lip, cleft palate
59
Risk of neural tube defects is greatest with the use of which AED during pregnancy?
Valproate
60
If a woman with epilepsy has not required meds for a long tome before getting pregnant and has a seizure during pregnancy, what would be the best choice of medication?
Phenytoin
61
What are the AEDs that INDUCE hepatic enzymes?
Carbamazepine
Phenytoin (phenynduce)
Topiramate
62
What is Kindling?
Special mechanism that creates a SECONDARY seizure focus
Repeated stimulation w/ subconvulsive electrical pulses from an established focus ELSEWHERE
63
What would you find on EEG during the clonic phase of seizures?
Spikes mixed with slow waves -> polyspike and wave
64
Focal type of seizure is more common:
a. On awakening
b. During sleep
Ans: B
Generalized sz - on awakening
Focal sz - during sleep
65
Which of the ff is NOT TRUE of TYPICAL absence?
A. 1/2 will at some time have GTCs
B. Patients can at times fall
C. They are able to continue complex acts
D. 1/3 have myoclonic jerks w/o LOC
B. Patients can at times fall
Patients DO NOT FALL in TYPICAL absence
66
Main (3) features of atypical absence
LOC is less complete
Myoclonus is prominent
EEG: 2-2.5/s SW or irregular 4-6Hz polySW
67
Regarding pharmacotherapy for JME:
A) What is the treatment?
B) Which AEDs should you avoid?
A) Valproic Acid
| B) Carbamazepine, Phenytoin
68
What is the semiology of the jacksonian march?
Hand -> arm -> face -> leg
Or
Leg -> arm -> face
69
LGI1 gene mutation is associated with what condition?
Autosomal Dominant Partial Epilepsy with Auditory Features
70
Unfamiliarity in a familiar circumstance
Jamais vu
71
Depersonalization
| Dream-like state, pt views himself as an external observer
Autoscopy
72
Objects in the environment may perseverate as the head is moved
Palinopsia
73
[Automatisms]
Patient walks repetitively in small circles
a. Volvular Epilepsy
b. Epilepsia Procursiva
c. Poriomania
a. Volvular Epilepsy
74
[Automatisms]
Patient wanders aimlessly
a. Volvular Epilepsy
b. Epilepsia Procursiva
c. Poriomania
c. Poriomania
75
[Automatisms]
Patient runs
a. Volvular Epilepsy
b. Epilepsia Procursiva
c. Poriomania
b. Epilepsia Procursiva
76
What is the epidemiology and clinical presentation of Rolandic/Sylvian Epilepsy or Benign Epilepsy of Childhood w/ Centrotemporal Spikes?
5-9 years old
Nocturnal focal TC -> clonic contractions u/l face > extremity
77
What “greatly accentuates spikes” in Panayiotopoulos Syndrome?
Sleep
78
How would you differentiate temporal lobe seizures from absence? (aura vs automatism?)
Temporal seizures have DISTINCT ictal and post-ictal phases.
In absence, there's INSTANTANEOUS return post-ictal
79
What is the most common type of reflex epilepsy?
Visually-induced seizures
```
Other evocative stimuli:
Auditory
Somatosensory
Writing/reading
Eating
```
80
Associated factors for Sudden Unexplained Death in Epilepsy?
Inc duration and severity of epilepsy
History of GTC
In children: tx-resistant ep, devt delay, syndromes
81
5-9 years of age, AD
Nocturnal tonic-clonic seizures w/ focal onset
Progress to clonic contractions of one side of the face
EEG: high voltage spikes in contralateral lower rolandic/centrotemporal area
Controlled by single AED. Disappears during adolescence.
Rolandic/Sylvian Epilepsy
Benign Epilepsy of Childhood w/ centrotemporal spikes
82
True or False: Intelligence is usually preserved in Infantile Spasms (West Syndrome)
False
Most are left mentally impaired
83
True or false: medial temporal lobe epilepsy is more common in patients with complex febrile seizures
True
84
Psychogenice states that generate pseudoseizures
Panic disorder
Dissociative disorders
Malingering
85
Notable details of psychogenic seizures
| 4 clinical features, 2 diagnostic
Clinical
1. Eyes closed
2. Rapid breathing
3. Tongue biting, front
4. Highly resistant epilepsy w / normal cognitive function and imaging
Diagnostic
1. Normal CK post ictus
2. Normal EEG during attack
86
True or false: epileptic foci are aensitive to Acetylcholine
True
87
Percentage of abnormal EEGs
A) 1 EEG during interictal state
B) several recordings
A) 30-50%
| B) 60-70%
88
Imaging abnormalities in sz;
A) Focal post ictal
B) prolonged sz
C) withdrawal of AEDs
A) Focal: cortical swelling
B) prolonged: restricted diffusion hippocampi, posterior thalamus
C) AEDs withdrawal: changes in WM, splenium of CC
89
3 lab findings (serum) post seizure
Increased serum prolactin
Increased CK
Lactic acidosis
90
Which antibiotics cause seizures?
```
A) Imipenem
B) Penicillin congeners
C) Linezolid
D) Cefepime
E) All of the above
```
E) all of the above
91
Which of the following psychiatric meds are associated with seizures?
A) TCAs
B) Bupropion
C) Lithium
D) All of the above
D) All of the above
92
Which AED has non-linear kinetics once serum concentration exceeds 10mg/ml?
Phenytoin
93
Which AED is known to induce its own metabolism?
Carbamazepine
94
[AED interactions]
This drug reduces phenytoin concentration
Antacid
95
[AED interactions]
This drug increases phenytoin concentration
Antihistamine
96
[AED interactions]
This drug reduces warfarin levels
Phenobarbital or carbamazepine
| PaBABA) (caBABA
97
[AED interactions]
This drug increases warfarin levels
Phenytoin
| PhenyToin - PaTaas
98
[AED interactions]
This antibiotic increases levels of carbamazepine
Erythromycin
99
[AED interactions]
This antibiotic causes accumulation of phenytoin and phenobarbital
Chloramphenicol
100
[AED interactions]
This AED causes accumulation of phenytoin and phenobarbital
Valproate
101
[AED interactions]
These drugs decrease estradiol (3)
Phenytoin
Carbamazepine
Barbiturates
102
This gene is associated with increased skin eruptions from AEDs
A) in asians
B) in caucasians
A) asians: HLA-B*1502
B) caucasians: HLA-A*3101
103
Name the aed:
GABA potentiation
Na channel inhibition
T-type Ca Channel inhibition
NMDA inhibition
Valproic Acid
104
Name the aed:
GABA potentiation
Na channel inhibition
Ca Channel inhibition
AMPA inhibition
Topiramate
105
Give the MOA of this AED:
Valproic Acid
GABA potentiation
NMDA inhibition
Na channel inhibition
Ca (T-type) channel inhibition
106
Give the MOA of this AED:
Phenytoin
Na channel inhibitor
107
Give the MOA of this AED:
Carbamazepine
Na channel inhibitor
108
Give the MOA of this AED:
Phenobarbital
GABA potentiation
109
Give the MOA of this AED:
Lamotrigine
Na Channel inhibitor
110
Give the MOA of this AED:
Levetiracetam
SC2A modulation
111
Give the MOA of this AED:
Topiramate
GABA potentiation
AMPA inhibition
Na channel inhibition
Ca channel inhibition
112
Give the MOA of this AED:
Lacosamide
Na channel inhibition
113
Give the MOA of this AED:
Ethosuximide
Ca channel (T-type) inhibition
114
Give the MOA of this AED:
Gabapentin
Pregabalin
Ca channel inhibition
115
Give the MOA of this AED:
Perampanel
Glutamate (AMPA) inhibition
116
Give the MOA of this AED:
Vigabatrin
GABA potentiation
117
Give the MOA of this AED:
Propofol
GABA potentiation
| NMDA inhibition
118
Which AEDs cause Nephrolothiasis (2)?
Topiramate
| Zonisamide
119
Which AED is a hepatic enzyme inhibitor?
Valproic Acid
120
Which AED causes weight loss? (2)
Topiramate
| Zonisamide
121
Which AED causes weight gain?
Pregabalin
122
Which AED causes retinal toxicity?
Vigabatrin
123
Initial choice for GTC?
Valproate
| Carbamazepine
124
Initial choice for Myoclonic sz?
Valproate
| Levetiracetam
125
Initial choice for Absence?
Valproate
126
Initial choice for focal sz?
Carbamazepine
| Phenytoin
127
Initial choice for infantile spasms?
ACTH
| Vigabatrin
128
Initial choice for Lennox-Gastaut?
Valproate
129
Which AEDs induce hepatic enzymes?
| 3
Phenytoin
Carbamazepine
Topiramate
130
Most common cause of seizure for the ff age groups:
```
Age groups:
0-14
15-34
35-64
>65
```
```
Causes:
Congenital
Trauma
Infection
CV
Tumor
Degenerative
```
0-14: Congenital
15-34: Trauma
35-64: Cerebrovascular
>65: Cerebrovascular
131
AED which causes gingival hyperplasia
Phenytoin
132
AED that has autoinduction
Carbamazepine
133
AED with weight gain, PCOS, pancreatitis as SE
Valproic Acid
134
Mental dullness, drowsiness, dupuytren contractures are SEs of which AED?
Phenobarbital
135
AED with the longest half life
Phenobarbital
136
AED with the shortest half life
Fosphenytoin
