FINALS: SEIZURES

Question 1

Which age groups have the highest incidence of acute symptomatic seizures?

Answer 1

Children under 1 year old and the elderly.

Question 2

What is the estimated prevalence of epilepsy in the Philippines?

Answer 2

0.9%, approximately 900,000 individuals.

Question 2

What are common precipitating factors for seizures?

Answer 2

Fever
Traumatic Brain Injury (TBI)
Cerebrovascular disease
Drug withdrawal
Infection
Metabolic insults

Question 3

Define epilepsy based on the International League Against Epilepsy (ILAE).

Answer 3

Epilepsy is diagnosed if:

At least 2 unprovoked seizures >24 hours apart.
1 unprovoked seizure with at least a 60% probability of recurrence within 10 years.
Diagnosis of an epilepsy syndrome.

Question 4

Differentiate between seizure, epilepsy, and convulsion.

Answer 4

Seizure: Transient symptoms due to abnormal brain activity.
Epilepsy: Two or more unprovoked seizures.
Convulsion: Intense, repetitive muscular contractions.

Question 5

What is the most consistent predictor of seizure recurrence?

Answer 5

Documented etiology of the seizure.
Abnormal EEG (epileptiform or slow-wave patterns).

Question 6

Describe focal impaired awareness seizures.

Answer 6

Impaired awareness during part or all of the seizure.
May involve motor or non-motor symptoms.
A person may have a vague idea of the event but not full awareness.

Question 7

What are the two main phases of a generalized tonic-clonic seizure?

Answer 7

Tonic Phase: Sustained contractions, unconsciousness, cyanosis, cry/moan.
Clonic Phase: Alternating muscle contraction and relaxation, symmetric jerking.

Question 8

Define Status Epilepticus (SE).

Answer 8

A seizure that is prolonged or repeated in brief intervals, causing enduring neurological changes.

Question 9

What are the key features of the 2017 ILAE seizure classification?

Answer 9

Where the seizure begins in the brain.
Level of awareness during the seizure.
Motor and non-motor symptoms.

Question 10

What is Sudden Unexpected Death in Epilepsy (SUDEP)?

Answer 10

Sudden, unexpected, non-traumatic death in epilepsy patients without a clear toxicologic or anatomical cause, potentially triggered by seizure-induced cardiorespiratory alterations.

Question 11

What are the key features of a Generalized Tonic-Clonic seizure (Grand Mal)?

Answer 11

Abrupt loss of consciousness
Tonic phase: Bilateral tonic-clonic extension of trunk and limbs, epileptic cry
Clonic phase: Synchronous muscle jerking
Postictal state: Unarousable, lethargic, confused, often followed by sleep

Question 11

What should NOT be done during a Generalized Tonic-Clonic seizure?

Answer 11

Do not restrain the patient
Do not put anything in their mouth

Question 12

How can you recognize an Absence seizure (Petit Mal)?

Answer 12

Sudden interruption of consciousness
Motionless stare and arrest of ongoing activity
Fine clonic movements of eyelids or facial muscles may occur
EEG shows 3-per-second spike-and-wave pattern

Question 13

What age group commonly experiences Absence seizures?

Answer 13

Rarely before 4 years or after puberty. Seizures often diminish during adolescence.

Question 14

What is Juvenile Myoclonic Epilepsy?

Answer 14

Common in adolescents (~15 years old)
Myoclonic jerks typically occur in the morning
Associated with 4-6 Hz polyspike EEG bursts
Managed effectively with Valproic Acid

Question 14

What are the characteristics of Myoclonic seizures?

Answer 14

Brief, brusque muscle contractions
Can affect one muscle, a limb, or the entire trunk
May be benign or part of a neurodegenerative disease

Question 14

What happens during an Atonic seizure?

Answer 14

Sudden loss of muscle tone, which may be fragmentary or generalized.

Question 15

What distinguishes Idiopathic epilepsy from Secondary epilepsy?

Answer 15

Idiopathic: No identifiable cause; presumed genetic origin, often resolves spontaneously.
Secondary: Has an identifiable structural or acquired cause, often progressive, and associated with neurological deficits.

Question 16

What conditions can be mistaken for seizures?

Answer 16

Syncope (most common)
Psychogenic events
Breath-holding spells
Sleep and movement disorders

Question 17

What are the steps in seizure first aid for generalized convulsions?

Answer 17

Lay the patient on the floor.
Place something soft under their head.
Loosen tight clothing around the neck.
Turn their head to the side.
Remove sharp objects from the vicinity.
Time the seizure.

Question 18

What are indications for IV antiepileptic drugs?

Answer 18

Acute seizures or status epilepticus
Rapid initiation of therapy or correction of AED levels
Inability to swallow medication

Question 19

When should an EEG be requested in epilepsy?

Answer 19

To confirm epilepsy diagnosis
Classify seizure type
Diagnose non-convulsive status epilepticus

Question 20

Which imaging modality is better for epilepsy diagnosis: CT or MRI?

Answer 20

MRI: Higher sensitivity for structural anomalies (e.g., hippocampal sclerosis, congenital brain malformations).
CT: Preferred when MRI is unavailable or contraindicated (e.g., pacemakers).

Question 21

What type of seizure is characterized by brief staring spells, a sudden “zoning out,” and 3-Hz spike-and-wave discharges on EEG?

Answer 21

Absence seizure (formerly called petit mal seizure).

Question 22

What EEG finding is diagnostic for absence seizures?

Answer 22

Generalized 3-Hz spike-and-wave discharge during hyperventilation.

Question 22

What is the typical prognosis for absence seizures in children?

Answer 22

The prognosis is generally good; most children outgrow the seizures by adolescence.

Question 23

What is the first-line pharmacologic treatment for absence seizures?

Answer 23

Ethosuximide is the first-line treatment; valproic acid is an alternative.