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RACP Written Exam Cram Series > Epilepsy Exam Cram > Flashcards

Epilepsy Exam Cram Flashcards

1
Q

What kind of seizure?

3Hz spike wave

A

Absence

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2
Q

What kind of seizure?

Centrotemporal sharp waves

A

Benign epilepsy with centrotemporal spikes / Benign Rolanic Epilepsy

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3
Q

What kind of seizure?

Frequent right occipital spikes

A

Occipital epilepsy of childhood (Gastaut type)

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4
Q

What kind of seizure?

High amplitude sharp and slow complexes mostly occipital?

A

Benign Occipital Epilepsy (Panayiotopoulos type)

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5
Q

What kind of seizure?

Hypsarrhythmia

A

Infantile spasm

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6
Q

What kind of seizure?

Burst suppression

A

Normal in preterm infant

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7
Q

Late pre-term baby, apgars 9,9 with focal seizure with apnoea day 5 of life. No further seizures since. Normal neuro exam. Normal labs, CSF & neuroimaging. What kind of epilepsy?

A

Benign neonatal seizures

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8
Q

Neonate with multifocal clonic or tonic seziures in first week of life. FHx of neonatal seizures. What kind of epilepsy?

A

Benign familial neonatal seizures

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9
Q

Mutation causing benign familial neonatal seizures?

A

KCNQ2 and KCNQ3

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10
Q

Encephalopathic ex-term baby with erratic myoclonus. EEG shows burst suppression mostly during sleep. What epilepsy?

A

Early myoclonic epilepsy

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11
Q

2-3mo baby with dev delay, soasticity and focal motor seizures. MRIB shows structural brain abnormality. What epilepsy?

A

Early infantile epileptic encephalopathy
50% death, 50% severe neurological impairment

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12
Q

Ex prem baby.Normal neuro exam. Milestones not delayed for corrected age. EEG shows burst suppression. What epilepsy?

A

Normal baby.

Burst suppression normal variant in pre-term babies.

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13
Q

6mo with epileptic spasms usually after waking and developmental regression. EEG shows hypsarrhythmia. What kind of epilepsy?

A

Infantile spasms / West Syndrome

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14
Q

Most common cause of infantile spasms?

A

Focal cortical dysplasia

Other aetiologies:
TS / neurocutaneous disorders
T21 / chromosomal disorders
Inborn errors of metabolism
Peri/post-natal insults

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15
Q

Investigations of choice for infantile spasms?

A

EEG
MRIB
Metabolic workup

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16
Q

Treatment of choice for infantile spasms?

A

ACTH
Corticosteroids
Vigabatrin (first line in TS)

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17
Q

<18mth infant presenting with febrile status epilepticus, parents reporting developmental regression/plateau?

A

Dravet Syndrome

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18
Q

Mutation in Dravet Syndrome?

A

SCN1A

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19
Q

Treatment of choice for Dravet syndrome?

Drugs to avoid?

A

Valproate
Adjunctive clobazam

AVOID sodium channel blockers in carbamazepine

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20
Q

Afebrile seizures in infancy, ceasing by age 2 with no developmental concerns?

A

Benign familial epilepsy if FHX
Benign focal epilepsy

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21
Q

8 year old presenting w generalised tonic-clonic seizure during sleep, also has seizures involving the face/tongue/upper limb. EEG demonstrates centrotemporal spikes activated by sleep. What epilepsy?

A

Benign epilepsy with centrotemporal spikes / Rolandic epilepsy

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22
Q

Management of Rolandic / BECTS ?

A

No need for AEDs if seizures non-compromising
First line valproate

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23
Q

4 year old presenting with night time seizure with autonomic symptoms lasting >5min. EEG shoes occiptal/multifocal discharges. What epilepsy?

A

Benign occipital epilepsy - early onset (Panayiotopolous)

24
Q

Management of benign occipital epilepsy?

A

50% of patients only have 1 seizures
If AED req -> carbamazepine first line

25
Q

9 year old presenting with day time seizure involving vision, without loss of consciousness. EEG shows occipital spike wave complexes activated by eye closure. What epilepsy?

A

Occipital epilpesy - late onset - Gastaut

26
Q

Treatment of late onset occipital epilepsy (Gatsaut)?

A

Carbamazepine

27
Q

Frequent absence seizures in pre-school/primary school aged child. In your clinic you can induce absence seizure with hyperventilation. EEG shows 3Hz spike waves during episode with normal background activity. What epilepsy?

A

Childhood absence epilepsy

28
Q

Management of childhood absence epilepsy?

A

Ethosuxamide, sodium valproate
Lamotrigine second line

AVOID carbamazepine, keppra (ineffective)

29
Q

5yo with daily severe seizures. Seen in your clinic wearing a helmet. Was neurodevelopmentally normal prior to first seizure but now plateau/regressed. EEG shows inter-ictal pattern of slow spike and wave <2.5Hz. What epilepsy?

A

Lennox-Gastaut

30
Q

4yo with generalised epileptic seziures with a significant family history of same. Wearing a helmet when presented to your clinic. EEG shows 4Hz theta bursts, fast generalised spike waves and photosensitivity. What epilepsy?

A

Myoclonic-atonic epilepsy

31
Q

Management of myoclonic-atonic epilepsy / Doose syndrome?

A

Ketogenic diet

32
Q

5 year old presents with regression of language starting age 3.5-4. Parents initially thought hearing was impaired but had a normal hearing screen. EEG demonstrates continuous epileptiform (electrical status) during sleep. What epilepsy?

A

Landau-Kleffner

33
Q

Teenager presenting with myoclonic jerks after waking in the morning/absence seizures. Usually worse after staying up all night playing video games or going to a party with friends. There is a family history of epilepsy. What epilepsy?

A

Juvenile myoclonic epilepsy

34
Q

Management of juvenile myoclonic epilepsy?

A

Valproate

35
Q

Seizure involving sudden laughing or crying?

A

Gelastic seizure
Hypothalamic harmatoma

36
Q

Metabolic test for neonatal seizures onset 1mo - 4mo? Seziures might be increased before feeding time.

A

GLUT1

37
Q

What drugs to void in absence epilepsies?

A

Carbamazepine (worsens)
Keppra (ineffective)

38
Q

Common choice of AED for most childhood epilepsies?

A

Valproate

39
Q

Common choice of AED for neonatal seizures?

A

Phenobarb

40
Q

SEs of Carbamazepine?

A

Rash, SJS, leukopenia, hyponatremia

Dipolpia sign of toxicity

41
Q

SEs of valproate?

A

Weight gain, hair loss, pancreatitis, liver failure

42
Q

SEs of phenbarb?

A

Rash

43
Q

SEs of phenytoin?

A

Rash, serum sickness, hirsutism, gum hypertrophy, osteoporosis

44
Q

SEs lamotrigine?

A

Rash, SJS, hypersensitivity

45
Q

Allele screening recommended prior to commencing AED in people of Asian descent? Why?

A

HLA-B15:02
Increased risk of SJS/TEN in carbamazepine, phenytoin, oxcarbazine

46
Q

AEDs associated w low bone density and osteoporosis?

A

Valproate, phenytoin, topiramate

47
Q

Risk of teratogenicity with valproate?

A

10%

Risk is reduced if dose <900mg/day

Neural tube defects

48
Q

CYP450 inducers? Cause increased clearance and decreased steady state of other drugs?

A

Phenobarbitone
Phenytoin
Carbamazepine
Topiramate

49
Q

CYP450 inhibitors? Cause idecreased clearance and increased steady state of other drugs?

A

Valproate

50
Q

Na+ channel blockers?

A

Phenytoin
Carbamazepine
Oxcarbazepine
Valproate
Topiramate
Lamotrigine

51
Q

GABAergic drugs?

A

Phenobarb
Benzos
Vigabatrin
Valproate

52
Q

Risk factors for pharmacologically resistant epilepsy?

A

Cryptogenic epilepsy

Early onset <1yr

High number of seizures prior to commencing AED

Failures of 1st and 2nd AED

53
Q

Predictors of good response in AED therapy?

A

Age <12

54
Q

Most teratogenic AED?

Safest AED for pregnancy?

A

Valproate most teratogenic

Lamotrigine or Leveciracetam preferred

55
Q

Genetic mutation in juvenile myoclonic epilepsy?

A

GABRA1

RACP Written Exam Cram Series (19 decks)

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