Exam 3 -- Epilepsy

Question 1

Epilepsy is characterized by decreased amounts of which neurotransmitter? And increased activation of which receptors?

Answer 1

Decreased GABA (decreased inhibition) and increased NMDA activation (increased excitation)

Question 2

Tonic-clonic (grand mal) is a type of generalized seizure. It includes a tonic phase, a clonic phase, and a postictal recovery phase. About how long does each of these phases last?

Answer 2

Tonic = 10-20 seconds; clonic = 30-90 seconds, and postictal = 5-30 minutes

Question 3

What is the name for the postictal paresis that can sometimes occur in a patient after a tonic-clonic seizure?

Answer 3

Todd’s paralysis; it typically lasts less than 48 hours

Question 4

In order to consider a diagnosis of status epilepticus, what must be true?

Answer 4

There must have been a seizure lasting more than 30 minutes, OR at least two seizures without full recovery between.

Question 5

True or false: absence seizures (petite mal) are convulsive seizures.

Answer 5

False; they are non-convulsive.

Question 6

Give a one-sentence description of a tonic seizure.

Answer 6

Sudden muscle stiffness with or without impaired consciousness.

Question 7

Give a one-sentence description of a clonic seizure.

Answer 7

Muscle spasms with or without impaired consciousness.

Question 8

Give a one-sentence description of a myoclonic seizure.

Answer 8

Sudden, brief muscle contractions lasting 1-2 seconds, without impaired consciousness.

Question 9

In terms of partial/focal seizures, which involves impairment of consciousness, and which does not?

Answer 9

Complex impairs consciousness, simple does not.

Question 10

Jacksonian march is associated with what type of seizure?

Answer 10

Simple partial.

Question 11

Which type of seizure is most common?

Answer 11

Complex partial.

Question 12

True or false: a complex partial seizure usually lasts three minutes or less, during which time the patient either remains motionless or engages in automatisms.

Answer 12

True.

Question 13

Which drugs are broad spectrum anti-epileptic drugs?

Answer 13

Lamotrigine, topiramate, valproate

Question 14

True or false: ethosuximide and gabapentin are both acceptable drugs for absence seizures

Answer 14

False; only ethosuximide; gabapentin is contraindicated.

Question 15

Which drugs are anti-epileptic drugs for focal seizures?

Answer 15

Carbamazepine, phenytoin, phenobarbital, gabapentin.

Question 16

What is the drug of choice to treat general seizures? What pregnancy category does this drug fall into?

Answer 16

Valproate; Category D. Note: valproate can also be used for anti-convulsion in MS.

Question 17

What is the drug of choice to treat focal seizures?

Answer 17

Lamotrigine

Question 18

What are the common side effects of anti-epileptic drugs?

Answer 18

N&V, diarrhea, dizziness, weight gain, skin rash, blood dyscrasias, interaction with other medications, diplopia, blurred vision, nystagmus, color changes.

Question 19

Which anti-epileptic medication is associated with myopic shift and angle closure? For bonus points, which other condition can this drug be used for?

Answer 19

Topiramate; can also be used for idiopathic intracranial hypertension.

Question 20

For focal seizures, surgical removal of the area causing the seizure is a treatment option, leaving 65-75% of patients seizure free. What is the most common site of the surgery?

Answer 20

Temporal lobe.

Question 21

What other treatment options, besides drugs and surgery, may be used to help with seizures?

Answer 21

Vagus nerve stimulation, and NeuroPace (brain implant that interrupts seizures automatically)

Question 22

Epilepsy prognosis is fairly good if controlled with medications. Children with epilepsy have a 3-4x increased risk of death. Sudden, unexplained death in epilepsy (SUDEP) occurs in 2-18% of patients with epilepsy.

Answer 22

Free card.