Epilepsy_Pretest

Question 1

EEG: Classic 3Hz spike and wave pattern

Answer 1

ABSENCE SEIZURE

Question 2

EEG: 1-2 Hz Ddx

Answer 2

SEVERE NEUROLOGIC DYSFUNCION + SX GENERALIZED EPILEPSY

Question 3

CONNORS RATING SCALE is useful for diagnosis of __?

Answer 3

ADHD - Tests inattention and hyperactivity

Question 4

What are the common triggers of seizures?

Answer 4

LACK OF SLEEP, NON-COMPLIANCE WITH MEDS**

Prescription, illicit drug use
Psychological stress

Question 5

What is the benefit of using LORAZEPAM vs DIAZEPAM in STATUS EPILEPTICUS?

Answer 5

DIAZEPAM - Rapid onset of action in brain BUT HIGH Vd (rapid distribution to body). Would need additional meds to prevent seizure 20min after

LORAZEPAM - Better bec rapid onset of action in brain BUT LOW Vd (redistributes in body fairly slowly) - Stays in the brain longer

Question 6

What is the most common side effect of PHENYTOIN >50MG/MIN (usually administered after LORAZEPAM fails in STATUS EPILEPTICUS pt)?

Answer 6

CARDIAC ARRHYTHMIA + HYPOTENSION

Generally takes 20min to administer 1000-1500mg standard dose

Question 7

What is FOSPHENYTOIN?

Answer 7

Water-soluble PRODRUG of PHENYTOIN that has the advantage of causing FEWER INFUSION SITE RXNS (given at 150mg/min - bigger dose than phenytoin)

Question 8

What are the advantages of FOSPHENYTOIN vs phenytoin usage when seizing pt is REFRACTORY TO LORAZEPAM?

Answer 8

1) FOSPHENYTOIN - Can be given at a greater dose rate (<150mg/min vs phenytoin <50mg/min) before cardiac arrhythmia can be induced
2) FOSPHENYTOIN - Can be administered INTRAMUSCULARLY when IV access is difficult

Question 9

If a pt has a PARTIAL SIMPLE SEIZURE, what is the most useful workup?

Answer 9

**MRI - Determine if there is a focal brain lesion

EEG is not as useful because the seizure activity is not occurring at that point

Question 10

In KIDS: MENTAL DYSFN + MULTIPLE SEIZURES + 1-2HZ generalized spike-wave pattern + seizures that are difficult to control = ?

Answer 10

LENNOX-GASTAUT SYNDROME

Question 11

INFANTILE SPASMS + PAROXYSMAL NECK FLEXION + LIMB EXTENSION + MENTAL RETARDATION + PROFOUNDLY DISORGANIZED EEG PATTERN (HYPSARRHYTHMIA - Diffuse, high-voltage, polyspike-and-slow wave) = ?

Answer 11

WEST SYNDROME

Question 12

LOSS OF LANGUAGE FUNCTION + ABNORMAL EEG PATTERN DURING SLEEP = ?

Answer 12

LANDAU-KLEFFNER SYNDROME

LAN - for language, KLEF - for puffy pillows (sleep abnormal EEG)

Question 13

Benign epilepsy syndrome with ONSET IN LATE ADOLESCENCE/EARLY ADULTHOOD

Answer 13

JUVENILE MYOCLONIC EPILEPSY

Question 14

GENERALIZED TONIC-CLONIC SEIZURES + FEVER in child who’s otherwise healthy?

Answer 14

FEBRILE SEIZURES

Question 15

When is an alcoholic at greatest risk of a SEIZURE? of DELIRIUM TREMENS?

When do withdrawal sx generally resolve?

Answer 15

Day 1 = greatest risk of ALCOHOLIC WITHDRAWAL SEIZURE
Day 2-4 = “ “ “ DT
Day 7-14 = Withdrawal resolves

Question 16

Where is the lesion most likely to show in a pt p/w NAUSEA, WARMTH OVER BODY, UNUSUAL ODOR OF ROTTING (olfactory hallucination) + twitching + inability to speak?

What are the most common etiologies?

Answer 16

MESIAL TEMPORAL LOBE - particularly HIPPOCAMPUS or PARAHIPPOCAMPAL GYRUS

ETIOLOGY: MTS, TUMORS, TRAUMA

Question 17

Why is PROPHYLACTIC PHENYTOIN given to an ICU pt with TBI?

Answer 17

To REDUCE incidence of EARLY POST-TRAUMATIC SEIZURES (can lead to increased morbidity and prolonged hospital stays)

Question 18

What is the most common complication of TEMPORAL LOBECTOMY?

Answer 18

CONTRALATERAL SUPERIOR QUADRANOPIA - Interruption of optic tracts passing over temporal lobe

More common than hemianopsia, hemiparesis, and language deficits

Question 19

What is the most common cause of INTRACTABLE PARTIAL COMPLEX SEIZURES in adults? What is the classic EEG finding?

Answer 19

MEDIAL TEMPORAL SCLEROSIS

EEG: Interictal anterior temporal spike and wave complexes

Question 20

In MTS pts, what is a common neurological PMHx? What is the most recommended Tx?

Answer 20

PMHx: FEBRILE SEIZURES as a child

Tx = SURGICAL RESECTION (70% seizure free at 2 years)

Question 21

What is SECONDARY GENERALIZATION in context of a seizure?

Answer 21

PARTIAL SIMPLE SEIZURE that becomes GENERALIZED

Question 22

Pt has a seizure that begins in the HAND -> Second generalization -> LOC -> Generalized tonic clonic seizure

What seizure is this?

Answer 22

JACKSONIAN MARCH - SEQUENTIAL SEIZURE

Pt develops focal seizure activity (primarily motor) -> Spreads

Question 23

Where are the two most common sites involved in a JACKSONIAN/SEQUENTIAL SEIZURE?

Answer 23

HAND(thumb), or FACE(mouth) since thumb and mouth are located near each other in cerebral homonculi

Question 24

Which pathology are MYOCLONIC SEIZURES most commonly seen in? How does this pathology differ from SLEEP MYOCLONUS?

Answer 24

BENIGN JUVENILE MYOCLONIC EPILEPSY (BJME)

BJME - Occurs when pt WAKES UP from sleep
SLEEP MYOCLONUS - When pt is sleeping

Question 25

Are MYOCLONIC SEIZURES general or partial? What are the common triggers?

Answer 25

Can be BOTH GENERALIZED or partial

Triggers: Flashing lights, loud sounds

Question 26

What is the most common aura of PARTIAL COMPLEX SEIZURES?

Answer 26

VISUAL AND OLFACTORY HALLUCINATIONS - unpleasant smell/taste

Question 27

What are the two possible criteria of STATUS EPILEPTICUS?

Answer 27

1) CONTINUOUS seizing activity for 30min

2) SERIES of seizures over 30min period w/o pt regaining consciousness

Question 28

Pt develops CONTINUOUS RHYTHMIC jerking of left corer of mouth + left thumb. Lasts >24hrs. What type of seizure is this?

Answer 28

EPILEPSIA PARTIA CONTINUALIS - Focal motor status epilepticus (persistent focal motor seizure activity)

Question 29

Where are the most commonly affected sites of EPILEPSIA PARTIALIS CONTINUA?

Answer 29

DISTAL HAND/FOOT MUSCLES

May be exacerbated by active/passive ROM and lasts for hours-months

Question 30

What is the mode of Tx for broad spectrum GENERALIZED or PARTIAL seizures?

Answer 30

LEVETIRACETM - Keppra due to least side effects

Question 31

What is the mode of Tx for WEST SYNDROME? What is a common cause for this?

Answer 31

ACTH (hormone)

Common cause = TUBEROUS SCLEROSIS

Question 32

What is the mode of Tx for ABSENCE SEIZURES (+LOC, -LOT, - Aura, - Post-ictal state)?

Answer 32

ETHOSUXIMIDE = DIVALPROEX SODIUM

Question 33

What differentiates PRE-ECLAMPSIA from ECLAMPSIA? What is the recommended Tx to prevent seizures for both pre-eclampsia and eclampsia?

Answer 33

NEW-ONSET GRAND MAL SEIZURES changes pregnant woman from pre-eclampsia to eclampsia

Recommended optimal treatment = MAGNESIUM SULFATE infusion

Question 34

What is the most common co-morbidity of ABSENCE SEIZURES?

Answer 34

ADHD

ANXIETY

Question 35

What are the differences between FOCAL SEIZURES and ABSENCE SEIZURES (can present very similarly)?

Answer 35

FOCAL: Originates from ONE cerebral hemisphere, NOT provoked by hyperventilation, + POST-ICTAL phase

ABSENCE: Originates from BOTH cerebral hemispheres, + Provoked by hyperventilation, - POST-ICTAL phase

Question 36

TRANSIENT FOCAL NEURO DEFICIT (usually hemiparesis) that occurs after a partial or generalized seizure = ?

Answer 36

TODD PARALYSIS

Sx are self-limiting and usually resolve

Question 37

How can one tell the difference between ABSENCE SEIZURES and INATTENTIVE STARING SPELLS?

Answer 37

ABSENCE: + Automatisms (eyelid fluttering, lip smacking), LOC, Length <20sec

STARRING SPELLS: - Automatisms, -LOC, Variable length