Epilepsy Exam Cram Flashcards by Olivia Wells

What kind of seizure?

3Hz spike wave

Absence

How well did you know this?

Not at all

Perfectly

What kind of seizure?

Centrotemporal sharp waves

Benign epilepsy with centrotemporal spikes / Benign Rolanic Epilepsy

How well did you know this?

Not at all

Perfectly

What kind of seizure?

Frequent right occipital spikes

Occipital epilepsy of childhood (Gastaut type)

How well did you know this?

Not at all

Perfectly

What kind of seizure?

High amplitude sharp and slow complexes mostly occipital?

Benign Occipital Epilepsy (Panayiotopoulos type)

How well did you know this?

Not at all

Perfectly

What kind of seizure?

Hypsarrhythmia

Infantile spasm

How well did you know this?

Not at all

Perfectly

What kind of seizure?

Burst suppression

Normal in preterm infant

How well did you know this?

Not at all

Perfectly

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?

Benign neonatal seizures

How well did you know this?

Not at all

Perfectly

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

Benign familial neonatal seizures

How well did you know this?

Not at all

Perfectly

Mutation causing benign familial neonatal seizures?

KCNQ2 and KCNQ3

How well did you know this?

Not at all

Perfectly

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

Early myoclonic epilepsy

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

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

Normal baby.

Burst suppression normal variant in pre-term babies.

How well did you know this?

Not at all

Perfectly

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

Infantile spasms / West Syndrome

How well did you know this?

Not at all

Perfectly

Most common cause of infantile spasms?

Focal cortical dysplasia

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

How well did you know this?

Not at all

Perfectly

Investigations of choice for infantile spasms?

EEG
MRIB
Metabolic workup

How well did you know this?

Not at all

Perfectly

Treatment of choice for infantile spasms?

ACTH
Corticosteroids
Vigabatrin (first line in TS)

How well did you know this?

Not at all

Perfectly

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

Dravet Syndrome

How well did you know this?

Not at all

Perfectly

Mutation in Dravet Syndrome?

SCN1A

How well did you know this?

Not at all

Perfectly

Treatment of choice for Dravet syndrome?

Drugs to avoid?

Valproate
Adjunctive clobazam

AVOID sodium channel blockers in carbamazepine

How well did you know this?

Not at all

Perfectly

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

Benign familial epilepsy if FHX
Benign focal epilepsy

How well did you know this?

Not at all

Perfectly

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?

Benign epilepsy with centrotemporal spikes / Rolandic epilepsy

How well did you know this?

Not at all

Perfectly

Management of Rolandic / BECTS ?

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

How well did you know this?

Not at all

Perfectly

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

Benign occipital epilepsy - early onset (Panayiotopolous)

Management of benign occipital epilepsy?

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

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?

Occipital epilpesy - late onset - Gastaut

Treatment of late onset occipital epilepsy (Gatsaut)?

Carbamazepine

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?

Childhood absence epilepsy

Management of childhood absence epilepsy?

Ethosuxamide, sodium valproate Lamotrigine second line AVOID carbamazepine, keppra (ineffective)

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?

Lennox-Gastaut

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?

Myoclonic-atonic epilepsy

Management of myoclonic-atonic epilepsy / Doose syndrome?

Ketogenic diet

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?

Landau-Kleffner

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?

Juvenile myoclonic epilepsy

Management of juvenile myoclonic epilepsy?

Valproate

Seizure involving sudden laughing or crying?

Gelastic seizure Hypothalamic harmatoma

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

GLUT1

What drugs to void in absence epilepsies?

Carbamazepine (worsens) Keppra (ineffective)

Common choice of AED for most childhood epilepsies?

Valproate

Common choice of AED for neonatal seizures?

Phenobarb

SEs of Carbamazepine?

Rash, SJS, leukopenia, hyponatremia Dipolpia sign of toxicity

SEs of valproate?

Weight gain, hair loss, pancreatitis, liver failure

SEs of phenbarb?

Rash

SEs of phenytoin?

Rash, serum sickness, hirsutism, gum hypertrophy, osteoporosis

SEs lamotrigine?

Rash, SJS, hypersensitivity

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

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

AEDs associated w low bone density and osteoporosis?

Valproate, phenytoin, topiramate

Risk of teratogenicity with valproate?

10% Risk is reduced if dose \<900mg/day Neural tube defects

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

Phenobarbitone Phenytoin Carbamazepine Topiramate

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

Valproate

Na+ channel blockers?

Phenytoin Carbamazepine Oxcarbazepine Valproate Topiramate Lamotrigine

GABAergic drugs?

Phenobarb Benzos Vigabatrin Valproate

Risk factors for pharmacologically resistant epilepsy?

Cryptogenic epilepsy Early onset \<1yr High number of seizures prior to commencing AED Failures of 1st and 2nd AED

Predictors of good response in AED therapy?

Age \<12

Most teratogenic AED? Safest AED for pregnancy?

Valproate most teratogenic Lamotrigine or Leveciracetam preferred

Genetic mutation in juvenile myoclonic epilepsy?

GABRA1