Epilepsy and Seizures

Question 1

EEG character of absence

Answer 1

3-Hz spike-and-wave

Likely nothing on MRI

Question 2

Symptomatic generalized epilepsy EEG findings

Answer 2

1-2 Hz

Question 3

What is the Conners Rating Scale

Answer 3

used for evaluation of inattention and hyperactivity (ADHD) given to parents at home and teachers at school

Question 4

Seizure triggers (5)

Answer 4

bright flashing lights
lack of sleep
hyperventilation
psychological stress
*missing AEDs*

Question 5

Advantage of Lorazepam (as opposed to other benzos) for status epilepticus

Answer 5

rapid acting, cleared more slowly from brain, less fat-soluble

Question 6

Which AED can cause cardiac arrhythmia

Answer 6

phenytoin, if given at >50 mg/min in adults or 1 mg/kg/min in children

Question 7

Strategies to decrease side effects of rapid phenytoin infusion

Answer 7

use Fosphenytoin (water-soluble prodrug of phenytoin that cause fewer infusion site rxns) but can give up to 150 mg/min in adults.

• can be intramuscular

Question 8

Adverse effects of IV phenobarbital

Answer 8

hypotension and respiratory arrest

Question 9

Adverse effects of diazepam and clonazepam (in high doses)

Answer 9

hypotension & autonomic depression

Question 10

First step in workup of simple partial seizure in middle-aged adult

Answer 10

Rule out brain lesion (CT & preferably MRI)

Question 11

Peak time period for alcohol withdrawal seizures

Answer 11

1-2 days after drinking cessation

Question 12

Peak time period for delirium tremens

Answer 12

2-4 days after drinking cessation

Question 13

Lennox-Gastaut EEG characteristics

Answer 13

Generalized 1-2 Hz spike-wave discharges

Question 14

People with Lennox-Gastaut usually has what history?

Answer 14

Infantile spasms

Question 15

Presentation of Infantile spasms

Answer 15

paroxysmal flexions of body, waist or neck and have disorganized EEG pattern called hypsarrhythmia

Question 16

Name the seizure: “hypsarrhythmia” on EEG

Answer 16

infantile spasms

Question 17

Name the seizure: 3 Hz spike-and-wave

Answer 17

absence

Question 18

Name the seizure: bi/triphasic sharp wave complexes

Answer 18

CJD

Question 19

kiddo with onset of episodes of loss of body tone, associated falls, generalized tonic-clonic seizures, deterioration of cognitive function

What does s/he have?

Answer 19

Lennox-Gastaut

Question 20

Landau-Kleffner syndrome

Answer 20

loss of language function & abnl EEG during sleep

Question 21

Juvenile Myoclonic Epilepsy

Answer 21

onset late adolescence/early adulthood, benign

Question 22

Presentation of febrile seizures

Answer 22

generalized tonic-clonic seizures associated with fever in child who is otherwise healthy

Question 23

Where is the lesion in pts with seizures preceded with aura of olfactory hallucination

Answer 23

Mesial temporal lobe, particularly HIPPOCAMPUS and parahippocampal gyrus

Question 24

Mesial temporal sclerosis is associated with

Answer 24

(also known as hippocampal sclerosis), associated with intractable temporal lobe epilepsy

Question 25

Purpose of AED use post head trauma

Answer 25

reduce incidence of EARLY posttraumatic seizures, which reduces morbidity and prolonged hospital stays

Question 26

Preferred AED for posttraumatic seizure ppx

Answer 26

phenytoin

Question 27

Most common complication of temporal lobectomy and whats the mechanism.

Answer 27

visual field defect from interruption of fibers from optic tracts passing over temporal horn of lateral ventricles

Superior quadrantanopsia

Question 28

Management of MTS

Answer 28

neurosurgery; resection of right anterior temporal lobe (80% effective)

Question 29

Jacksonian march presentation

Answer 29

(also known as sequential seizure)

starts as focal seizure activity (commonly in hand) primarily motor and spreads (commonly to face because thumb and mouth are near each other on the motor strip of cerebral cortex), secondarily generalizes, then pt lose consciousness and have generalized tonic-clonic seizures

Question 30

Benign Juvenile myoclonic epilepsy presentation

Answer 30

happens upon waking up, can be triggered by light flashes or loud sounds.

Question 31

sleep myoclonus

Answer 31

happens upon falling asleep…duh

Question 32

Complex-partial seizure presentation

Answer 32

could look like a psychiatric problem, have altered consciousness, but they don’t have any memory of abnormal behavior and can have auras

Question 33

uncinate fits

Answer 33

abnormal activity in the uncus of ttemporal lobe

Question 34

Status epilepticus lasts >_____minutes

Answer 34

> 30 minutes

Question 35

Complications of status epilepticus

Answer 35

respiratory failure, aspiration, acidosis, hypotension, rhabdo, renal failure, cognitive impairment

Question 36

Epilepsia partialis continua

Answer 36

persistent focal motor seizure activity (most commonly distal hand and foot muscles)

Question 37

Tx for epilepsia partialis continua

Answer 37

felbamate

Question 38

Tx of complex-partial seizure

Answer 38

levetiracetam

Question 39

Tx of seizure associated with West syndrome

Answer 39

ACTH

Question 40

West syndrome

Answer 40

generalized seizure disorder of infants w/ recurrent spasms, EEG pattern of hypsarrhythmia, mental retardation.

associated with tuberous sclerosis.

Question 41

Genaralized absence tx

Answer 41

(if non generalized: ethosuxamide)

in this case: divalproex sodium (valproic acid)

Question 42

Tx for prevention of seizures in preggos with pre-eclampsia or established eclampsia

Answer 42

MgSo4 (4-5 g IV load dose followed by 1g/h IV infusion)

Question 43

Example of reversible posterior leukoencephalopathy syndrome

Answer 43

eclampsia