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Epilepsy Modules > Introduction To Epilepsy Treatment: Module 3 > Flashcards

Introduction To Epilepsy Treatment: Module 3 Flashcards

1
Q
A
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2
Q

What is epilepsy?

A

A central nervous system (CNS) disorder caused by electrical dysfunction in the brain, leading to seizures.

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3
Q

What are the three key questions in diagnosing epilepsy?

A
  • Is the episode an epileptic seizure?
  • What is the seizure type?
  • What is the epilepsy syndrome?
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4
Q

How many people are estimated to be affected by epilepsy worldwide?

A

Approximately 65 million people.

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5
Q

What is the significance of seizure severity and impact in epilepsy?

A

It depends upon the part of the brain that is affected.

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6
Q

True or False: All seizures are epilepsy.

A

False.

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7
Q

What is the purpose of an electroencephalograph (EEG)?

A

Measures electrical activity in the brain.

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8
Q

What does continuous video-EEG monitoring combine?

A

Long-term EEG recording with video recording of an individual’s behavior.

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9
Q

What is the use of magnetic resonance imaging (MRI) in epilepsy diagnosis?

A

Detects structural abnormalities in the brain.

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10
Q

What is the function of computerized tomography (CT) in epilepsy evaluation?

A

Uses radiation to detect structural abnormalities in the brain.

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11
Q

What is magnetoencephalography (MEG) used for?

A

Detects abnormalities in the brain’s electrical activity.

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12
Q

What does positron emission tomography (PET) assess?

A

Glucose metabolism or blood flow in the brain.

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13
Q

What types of tests are included in genetic or metabolic testing for epilepsy?

A

Blood, urine, and spinal fluid tests.

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14
Q

Fill in the blank: The diagnostic procedure aims to determine if the episode is an _______.

A

[epileptic seizure]

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15
Q

What can mimic epileptic seizures?

A

A variety of conditions.

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16
Q

Why is MRI essential for patients undergoing a surgical evaluation for epilepsy?

A

Useful in determining seizure type.

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17
Q

What is the primary use of PET or SPECT in epilepsy diagnosis?

A

To assess areas where seizures arise, indicated by decreased glucose metabolism and blood flow.

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18
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19
Q

Why is an eyewitness account crucial in diagnosing epilepsy?

A

It is crucial for an accurate diagnosis and classification of seizure type

An eyewitness can provide details that are vital for understanding the context of the seizure.

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20
Q

What diagnostic tool is used to support the diagnosis of epilepsy?

A

Electroencephalography (EEG)

EEG helps to classify seizures and syndromes associated with epilepsy.

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21
Q

What is the preferred imaging technique for detecting structural abnormalities in the brain?

A

MRI

MRI is essential for diagnosing patients with suspected focal onset seizures.

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22
Q

What are the goals of therapy in epilepsy treatment?

A
  • Prevent further seizures
  • Avoid adverse effects
  • Improve quality of life
  • Enable patients to lead active lives

These goals apply to all treatment modalities including pharmacologic, surgical, dietary, or neurostimulation.

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23
Q

What is the first step after diagnosing epilepsy?

A

Selecting the best form of treatment, specifically the correct antiepileptic drug(s)

Antiepileptic drugs (AEDs) are the most common treatment for epilepsy.

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24
Q

What factors influence the decision to treat a patient with epilepsy?

A
  • Probability of seizure recurrence
  • Social and physical impact of additional seizures
  • Cause of the seizure
  • Informed consent from the patient or caregiver

These factors help neurologists assess the need for treatment.

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25
True or False: AEDs can cure epilepsy.
False ## Footnote AEDs can prevent additional seizures but do not cure the condition.
26
What can affect the risk for seizure recurrence?
* Seizure type * EEG results * Presence of congenital or neurological defects ## Footnote These factors are critical in assessing the likelihood of future seizures.
27
What is the rate of seizure recurrence for generalized seizures with normal EEG findings?
20% ## Footnote This statistic reflects the risk associated with generalized seizures when EEG results are normal.
28
What is the rate of seizure recurrence for focal seizures with abnormal EEG findings?
77% ## Footnote This indicates a higher risk for recurrence in focal seizures compared to other types with normal findings.
29
Fill in the blank: Most patients do well with the first one or two _______.
[antiepileptic drugs] ## Footnote This highlights the effectiveness of initial medication choices in managing epilepsy.
30
What is the primary function of medications in epilepsy treatment?
Stabilizing nerve cell membranes and preventing the spread of abnormal electrical discharge.
31
What is the usual focus of treatment with medication for epilepsy?
An adequate dose of a single medication.
32
What may some patients require for effective seizure control?
Multiple medications.
33
What should clinicians consider when treating with polypharmacy?
Mechanism of action of each medication and minimizing potential side effects.
34
What factors should be considered when choosing appropriate medication for epilepsy?
Age, gender, long-term treatment goals, health history, physiological and psychological side effects, potential interactions with other medications.
35
What are the treatment goals with AEDs?
* Eliminate seizures or reduce their frequency to the maximum degree possible * Evade adverse effects associated with long-term treatment * Aid patients in maintaining or restoring their usual psychosocial and vocational activities * Assist patients in maintaining a normal lifestyle.
36
What are the limitations and concerns of drug therapy for epilepsy?
Risk of side effects, drug interactions, nonadherence, and efficacy failure.
37
What percentage of patients with epilepsy are expected to enter remission?
60-70%.
38
How is remission defined in epilepsy treatment?
Five or more years of remaining seizure-free with medication.
39
What percentage of seizure-free people can be successfully withdrawn from pharmacotherapy after two to five years?
75%.
40
What percentage of new patients are not treated successfully despite ideal medical management?
10%.
41
What is required to choose the most suitable AED for a patient?
Knowledge of the characteristics of the epilepsy, the patient's medical history, and the available AEDs.
42
What factors should be considered in AED selection?
* Seizure type * Epilepsy syndrome * Efficacy * Cost * Pharmacokinetic profile * Adverse effects * Patient's related medical conditions.
43
What is the risk of adverse effects with pharmacotherapy for epilepsy?
Approaching 30% after initial treatment.
44
What are some common side effects of AEDs?
* Dizziness * Drowsiness * Mental slowing * Depression * Weight gain.
45
What are some serious side effects of AEDs?
* Metabolic acidosis * Skin rash * Liver toxicity * Colitis * Kidney failure * Glaucoma * Hepatotoxicity * Movement and behavioral disorders.
46
What are first-line AEDs?
Established medications that are tried first and taken on their own (monotherapy)
47
How are first-line AEDs chosen?
According to the patient's seizure type(s) and/or epilepsy syndrome, likelihood of side effects, risk of long-term effects, and low potential for pharmacokinetic interactions
48
Name three first-line AEDs for Primary Generalized Tonic-Clonic Seizures
* Levetiracetam * Lamotrigine * Topiramate
49
Name four first-line AEDs for Partial Seizures
* Oxcarbazepine * Zonisamide * Levetiracetam * Lacosamide
50
Which first-line AED is used for Absence Seizures?
Ethosuximide
51
Name two first-line AEDs for Atypical Absence Myoclonic, and Atonic Seizures
* Levetiracetam * Lamotrigine
52
True or False: All AEDs work through the same pathways
False
53
Fill in the blank: First-line AEDs are chosen based on the patient's seizure type(s) and/or _______ syndrome.
[epilepsy]
54
What is the first-line medication for generalized seizures?
Valproic acid (Depakote) ## Footnote Valproic acid is often used as a first-line treatment for generalized seizures.
55
Which medication enhances GABA?
Phenobarbital ## Footnote Phenobarbital works by enhancing GABA, a neurotransmitter that inhibits brain activity.
56
What is the mechanism of action (MOA) for Phenytoin (Dilantin)?
Sodium-channel Blocker ## Footnote Phenytoin primarily acts by blocking sodium channels to prevent seizure activity.
57
Fill in the blank: _______ is indicated for absence seizures.
Ethosuximide (Zarontin) ## Footnote Ethosuximide is specifically used for treating absence seizures.
58
What are the common side effects of Carbamazepine (Tegretol)?
Rash, nausea, dizziness, low white blood cell count, liver failure ## Footnote These side effects can significantly affect patient compliance and health.
59
Which medication is a sodium channel blocker and enhances GABA?
Oxcarbazepine (Trileptal) ## Footnote Oxcarbazepine has dual actions; it blocks sodium channels and enhances GABA activity.
60
True or False: Levetiracetam (Keppra) is a first-line choice for focal seizures.
True ## Footnote Levetiracetam is recognized as a first-line treatment option for focal seizures.
61
What is the adult dose range for Topiramate (Topamax)?
100 - 500 mg ## Footnote Topiramate dosage varies based on individual patient needs.
62
Which company manufactures Lamotrogine (Lamictal)?
GlaxoSmithKline ## Footnote Lamotrogine is produced by GlaxoSmithKline.
63
What is the indication for Zonisamide (Zonegran)?
Multiple choice for focal and generalized seizures ## Footnote Zonisamide can be used for both focal and generalized seizure types.
64
What are the side effects of Valproic acid (Depakote)?
Anemia, weight gain, transient hair loss, polycystic ovary disease, thrombocytopenia ## Footnote These side effects require monitoring during treatment.
65
Fill in the blank: Acetazolamide (Diamox) is used for _______.
adjunctive focal seizures; seizure clusters ## Footnote Acetazolamide is often used as an adjunct therapy in specific seizure types.
66
What is the common side effect of Lamotrogine (Lamictal)?
Rash and allergic reactions ## Footnote Patients need to be monitored for skin reactions when taking Lamotrogine.
67
Which medication has an unknown mechanism of action?
Zonisamide (Zonegran) ## Footnote The exact mechanism of action for Zonisamide is not well understood.
68
What is the adult dose range for Levetiracetam (Keppra)?
500 - 3000 mg ## Footnote The dosing for Levetiracetam varies widely based on clinical response.
69
What side effect is associated with Topiramate (Topamax)?
Nausea, weight loss, dizziness, speech difficulty, reduced concentration and memory ## Footnote These effects can impact a patient's daily functioning.
70
What are the side effects of Oxcarbazepine (Trileptal)?
Hyponatremia, weight gain, hair loss, somnolence, agitation, impaired concentration, blurred vision ## Footnote Monitoring sodium levels is critical with this medication.
71
Fill in the blank: The company that produces Phenobarbital is _______.
Novartis ## Footnote Phenobarbital is manufactured by Novartis.
72
What is the primary goal when titrating the dosage of a drug chosen by a neurologist?
To balance maximum efficacy with tolerability ## Footnote Titration is the process of adjusting the dosage to find the optimal therapeutic effect without causing unacceptable side effects.
73
What should a neurologist do if efficacy is not achieved at the highest tolerable dose?
Assess the reason for failure and switch to another drug from the same group ## Footnote This step is crucial to ensure that the patient receives the most effective treatment possible.
74
When is combination AED therapy typically used?
After failure of two monotherapies or if the first AED is well-tolerated but not fully effective ## Footnote AED stands for antiepileptic drug.
75
What are some risks associated with combination therapy?
* Drug interactions * Enhanced toxicity * Decreased patient adherence ## Footnote Patients may struggle with complex dosing schedules, impacting their willingness to follow the treatment plan.
76
What is the rationale behind choosing two drugs with different mechanisms of action in combination therapy?
To try to achieve synergistic effects ## Footnote Synergistic effects occur when the combined action of two drugs is greater than the sum of their individual effects.
77
What are the advantages of monotherapy compared to combination therapy?
* Better adherence * Fewer side effects * Cost-effectiveness ## Footnote Monotherapy is often preferred for initial treatment due to its simplicity and effectiveness.
78
What is the chance of remission with the first drug for patients with newly diagnosed epilepsy?
60% of patients achieve seizure control with the first or second AED ## Footnote This high rate of remission highlights the importance of initial drug selection in epilepsy treatment.
79
What is the purpose of newer drugs classified as second-line choices?
To be added to first-line drug therapy for greater seizure control ## Footnote Some neurologists may also use these newer drugs as first-line monotherapy despite being categorized as second-line.
80
What is a potential downside of polypharmacy in epilepsy treatment?
Higher risk of side effects and drug interactions ## Footnote Polypharmacy refers to the use of multiple medications, which can complicate treatment.
81
How frequently are newer drugs often dosed when used in combination with primary drugs?
Three or four times daily ## Footnote This frequent dosing can lead to a complicated medication schedule for patients.
82
What is Felbamate also known as?
Felbatol ## Footnote Felbamate is used as an adjunctive treatment for epilepsy.
83
What is the indication for Vigabatrin?
Adjunctive for focal seizures (drug of last choice) ## Footnote Vigabatrin is also indicated as a first-line treatment for infantile spasms.
84
What is Rufinamide used for?
Atonic and tonic seizures in Lennox-Gastaut syndrome (LGS) ## Footnote Rufinamide is an adjunctive treatment.
85
What type of seizures is Lacosamide indicated for?
Adjunctive for focal and generalized seizures; may be used early for tonic-clonic seizures ## Footnote Lacosamide is a sodium channel blocker.
86
What is the adult dose range for Clobazam?
8 - 12 mg ## Footnote Clobazam is indicated for adjunctive treatment of focal seizures.
87
What is the mechanism of action (MOA) for Ezogabine?
Potassium Channel Blocker ## Footnote Ezogabine is used for adjunctive focal seizures.
88
What are the side effects of Perampanel?
Dizziness, aggression, neuropsychiatric warning ## Footnote Perampanel is an AMPA receptor antagonist.
89
What is Gabapentin also known as?
Neurontin ## Footnote Gabapentin is used for adjunctive treatment of focal seizures.
90
Fill in the blank: Pregabalin is also known as _______.
Lyrica ## Footnote Pregabalin is indicated for adjunctive focal seizures.
91
What is the adult dose range for Tigabine?
15 - 45 mg ## Footnote Tigabine is used as adjunctive treatment for focal onset seizures.
92
What are the common side effects of Brivaracetam?
Drowsiness, mood changes, agitation, delusions, sleepiness, nausea, vomiting ## Footnote Brivaracetam is an adjunctive treatment for focal seizures.
93
True or False: Aplastic anemia is a side effect of Felbamate.
True ## Footnote Felbamate can cause serious side effects including liver failure.
94
What is the mechanism of action for medications produced by Lundbeck?
Sodium Channel Blocker ## Footnote Lundbeck produces medications for the treatment of epilepsy.
95
What type of drug is classified as a Class Ill drug?
Tigabine ## Footnote Tigabine is adjunctive for focal seizures.
96
What is the indication for Gabapentin?
Adjunctive for focal seizures ## Footnote Gabapentin is also used to treat neuropathic pain.
97
What is the adult dose range for Pregabalin?
900 - 3600 mg ## Footnote Pregabalin is indicated for adjunctive treatment of focal seizures.
98
What is the mechanism of action for Perampanel?
AMPA Receptor Antagonist ## Footnote Perampanel is indicated for adjunctive treatment of focal and generalized seizures.
99
Which AEDs lead market share in the U.S.?
Lamitical / Lamictal XR (lamotrigine), Vimpat (lacosamide), Keppra / Keppra XR (Levetiracetam) ## Footnote These three medications accounted for 45% of market share in 2013.
100
What is the market share percentage of Keppra / Keppra XR?
10% ## Footnote This represents its portion of the total market for epilepsy medications.
101
What are common medications for prolonged seizures and Status Epilepticus (SE)?
Benzodiazepines (lorazepam or diazepam), phenytoin, fosphenytoin, phenobarbital ## Footnote Intravenous formulations of sodium valproate, levetiracetam, and lacosamide are also used.
102
What characterizes Status Epilepticus (SE)?
Prolonged and/or frequent epileptic seizures lasting more than 30 minutes without regaining consciousness ## Footnote It is a life-threatening medical emergency.
103
When should emergency AED treatment begin for SE?
5-10 minutes from seizure onset ## Footnote Most neurologists recommend starting treatment within this time frame to minimize cerebral damage.
104
What are common causes of Status Epilepticus?
Nonadherence with AED, alcohol consumption, metabolic problems, significant infection, acute stroke, hypoxia ## Footnote These factors can lead to the occurrence of SE.
105
What percentage of the epilepsy product market is occupied by Vimpat?
17% ## Footnote This reflects its share in the U.S. epilepsy market.
106
What percentage of the epilepsy market is held by other branded medications?
7% ## Footnote This includes various other anti-epileptic drugs not specified.
107
Fill in the blank: Status epilepticus is diagnosed when seizure activity lasts for more than _______.
30 minutes
108
What is the role of EEG in the treatment of seizures?
Monitoring treatment response ## Footnote EEG is used to assess seizure activity and treatment effectiveness.
109
What is the percentage of the market share for Lamictal / Lamictal XR?
11% ## Footnote This indicates its presence in the anti-epileptic drug market.
110
True or False: Cerebral damage occurs during Status Epilepticus.
True
111
What percentage of the epilepsy market does Tegretol / Tegretol XR occupy?
1% ## Footnote This is a relatively small share compared to other AEDs.
112
What is the percentage market share for Trileptal?
2% ## Footnote This reflects its position in the market compared to other AEDs.
113
What percentage of the market is represented by Aptiom?
2% ## Footnote This is part of the overall epilepsy medication market.
114
What is the market share for Topamax?
2% ## Footnote This indicates its competitive standing in the epilepsy market.
115
What is the percentage market share for Sabril?
4% ## Footnote This medication is part of the broader epilepsy treatment landscape.
116
What percentage of the epilepsy market is occupied by Banzel?
3% ## Footnote Banzel's share reflects its usage among patients.
117
What is the market share for Trokendi XR?
3% ## Footnote This medication contributes to the overall market for anti-epileptic drugs.
118
At what age can seizures commonly begin?
Before age 20
119
What unique challenges do children with epilepsy face?
Variable needs related to developmental delays, depression, absence from school, and problems dealing with peers
120
What are the possible outcomes for children diagnosed with epilepsy?
Self-limiting epilepsy, no disease state, or devastating forms of epilepsy
121
Why do children with epilepsy require regular office visits?
To monitor their condition and evaluate treatment
122
What problems may arise from treating children with AEDs?
Negative effects on brain development, learning, and behavior
123
Why do children require frequent alterations in medication doses?
Because they grow rapidly
124
What metabolic factor may require higher medication dosages in children?
Increased metabolism
125
Who needs to supervise school-age children requiring medication during the day?
A school nurse
126
How can AED medications affect academic performance?
Side effects can alter brain functioning, cause sleepiness, and impair learning
127
Fill in the blank: Children with epilepsy may experience _______ related to their condition.
[developmental delays, depression, absence from school, problems dealing with peers]
128
What hormonal changes may affect men with epilepsy?
Hormonal fluctuations in their seizure patterns ## Footnote These fluctuations can influence the frequency and severity of seizures.
129
What is known about fertility and reproductive changes in men with epilepsy?
They are not well understood but seem to be fairly common and multifactorial ## Footnote This indicates that multiple factors may contribute to reproductive issues.
130
What psychological complications may affect men with epilepsy?
They may affect reproductive health and sexuality ## Footnote Psychological issues can lead to difficulties in intimate relationships.
131
What percentage of men with epilepsy report erectile dysfunction?
Approximately one third ## Footnote This statistic highlights the prevalence of sexual health issues in this population.
132
What challenges do clinicians face when treating men with epilepsy regarding sexual health?
Failure to recognize problems and patient reluctance to acknowledge issues ## Footnote This reluctance can hinder effective treatment and support.
133
What is the fertility rate of women with treated epilepsy compared to the general population?
One-quarter to one-third lower than that of the general population
134
What is the typical outcome for pregnancies in women with treated epilepsy?
They typically have productive pregnancies, delivering healthy babies
135
Why is AED monitoring essential during pregnancy?
Due to changes in metabolic processes
136
What is the seizure status of women whose epilepsy is well-controlled during pregnancy?
They will generally remain seizure-free during pregnancy and delivery
137
What may happen to women who have seizures before conception during pregnancy?
They may have increased seizures during pregnancy
138
What is one recommended action for women with epilepsy before becoming pregnant?
Work with healthcare provider(s) to determine the best choice of medication
139
What should women with epilepsy review with their healthcare providers before pregnancy?
Anticonvulsant risks and benefits
140
What should be discussed before pregnancy begins?
Medication changes
141
What supplement is recommended for women with epilepsy before and during pregnancy?
Folic acid and vitamin supplementation
142
What should be monitored during pregnancy for women taking anticonvulsants?
Medication levels
143
What should women avoid doing with their anticonvulsant medication during pregnancy?
Stopping an anticonvulsant abruptly
144
What should women explore to improve their quality of life during pregnancy?
Ways of preventing other negative effects
145
What should women keep current on during pregnancy?
Emerging research
146
What registry are women encouraged to enroll in if they take anticonvulsants and become pregnant?
The AED Pregnancy Registry
147
What population is at particular risk for developing epilepsy due to increased life expectancy?
Elderly ## Footnote The elderly population is particularly at risk for epilepsy, with common causes being stroke, brain bleeds, and neurodegenerative disorders.
148
What percentage of those over 70 is diagnosed with active epilepsy?
1.5% ## Footnote Nearly 1.5% of individuals over the age of 70 are diagnosed with active epilepsy.
149
What makes the diagnosis of epilepsy in elderly patients difficult?
Complex partial seizures presenting as confusion ## Footnote Complex partial seizures can be mistaken for psychiatric symptoms, complicating diagnosis.
150
What may contribute to physical injury sustained during a seizure in elderly patients?
Prolonged confusion post-seizure ## Footnote Confusion that occurs after a seizure may last longer in elderly patients, increasing the risk of injury.
151
What is a significant concern when treating elderly patients with epilepsy?
Multiple medications leading to drug interactions ## Footnote Elderly patients often take multiple medications, which can predispose them to drug interactions and enhance adverse effects.
152
What percentage of elderly patients achieve complete seizure control with AEDs?
More than 70% ## Footnote AEDs are credited with achieving complete seizure control in over 70% of elderly patients.
153
Which group of elderly patients continues to have seizures despite medication?
Those with neurodegenerative disease ## Footnote Patients with neurodegenerative diseases may continue to experience seizures even when treated with AEDs.
154
Why are elderly patients more sensitive to the adverse effects of AEDs?
Pharmacokinetic changes ## Footnote Sensitivity may be due to delayed gastric emptying, reduction in body fat, and decreased hepatic metabolism and renal elimination.
155
What treatment strategy is often employed for elderly patients due to their sensitivity to AEDs?
Low doses of AEDs ## Footnote Elderly patients are often treated with lower doses of antiepileptic drugs to mitigate adverse effects.
156
What is the risk percentage of developing epilepsy in mildly affected patients with learning disabilities?
5%
157
What is the risk percentage of developing epilepsy in patients with severe cerebral palsy or postnatal brain injury?
75%
158
Who typically conducts home assessments to diagnose epilepsy in patients with learning disabilities?
An epilepsy nurse
159
What is a common issue when diagnosing epilepsy in patients with learning disabilities?
Behavioral disorders may mimic epilepsy
160
Fill in the blank: AEDs and _______ can reduce the seizure threshold in patients with learning disabilities.
antipsychotic drugs
161
What was the duration of the study conducted on nonadherence to AEDs?
January 1997 - June 2006
162
What databases were used in the RANSOM study?
Medicaid databases from Florida, New Jersey, and Iowa
163
What was the primary focus of the RANSOM study?
The impact of nonadherence to AEDs on increased mortality, injury, and healthcare costs
164
What percentage increase in inpatient hospitalizations was associated with periods of nonadherence?
39%
165
What percentage increase in patient care days was associated with nonadherence?
76%
166
What percentage increase in emergency department visits was linked to nonadherence?
16%
167
What was the average additional cost per person for each nonadherent quarter?
$4,000
168
What percentage of patients in the study were determined to be adherent?
74%
169
What percentage of patients in the study were nonadherent?
26%
170
How many patients were included in the RANSOM study?
33,658 patients
171
What was the average follow-up duration for patients in the study?
4.65 years
172
What are the four outcome events analyzed in the study for healthcare utilization?
* Inpatient hospitalizations * Inpatient days * Emergency department visits * Outpatient visits
173
True or False: AED nonadherence is associated with lower costs for inpatient care.
False
174
What demographic factors were associated with nonadherence?
* Older age * Female gender * Non-white race * More comorbid conditions
175
What is the increased risk of death associated with AED nonadherence?
3-fold increased risk (p<0.001)
176
List some of the drugs evaluated in the RANSOM study.
* Carbamazepine * Ethosuximide * Felbamate * Gabapentin * Lamotrigine * Levetiracetam * Oxcarbazepine * Phenobarbital * Phenytoin * Pregabalin * Primidone * Tiagabine * Topiramate * Valproic acid * Zonisamide
177
What conclusion did the RANSOM study reach regarding AED nonadherence?
AED nonadherence is common and associated with greater healthcare utilization.
178
179
What percentage of individuals diagnosed with epilepsy fail to respond to medication?
30-40%
180
What is drug-resistant epilepsy (DRE)?
Failure of two appropriately chosen and tolerated AEDs to control seizures when used for an adequate period of time.
181
What are some risks associated with drug-resistant epilepsy?
* Structural damage to the brain * Comorbidities * Psychological consequences * Educational consequences * Social consequences * Hospitalizations * Health-related events * Mortality
182
What challenges do neurologists face in determining drug resistance in epilepsy?
Deciding how many AEDs to try before considering nonpharmacologic options.
183
What did the ILAE define as the criteria for drug-resistant epilepsy?
Failure of two appropriately chosen and tolerated AEDs to control seizures for an adequate period.
184
What was the focus of the study by Brodie and Kwan over 30 years?
Diagnosing and treating adolescents and adults with newly diagnosed epilepsy.
185
What was the impact of new AEDs on the response rate among adults with epilepsy?
Only a modest improvement.
186
What psychiatric comorbidity increases the likelihood of drug refractoriness?
Depression
187
What did Brodie and Kwan suggest as a treatment approach after AEDs fail?
Consider nonpharmacologic options such as epilepsy surgery or VNS Therapy.
188
What factors predict poorer outcomes in epilepsy treatment?
High seizure density before treatment.
189
Approximately what fraction of adults with epilepsy will not achieve remission with drug therapy?
One-third
190
Fill in the blank: Drug-resistant epilepsy may increase the risk for _______.
[structural damage to the brain, comorbidities, psychological consequences, educational consequences, social consequences, hospitalizations, health-related events, mortality]
191
True or False: The advent of new AEDs has led to significant improvements in seizure control for all patients.
False
192
What is the overall seizure-free rate after adequate trials of at least two AEDs?
Overall seizure-free rates with subsequent treatment trials dramatically decreased ## Footnote This finding is consistent across studies from 2000 and 2013.
193
What percentage of drug-resistant epilepsy patients are seizure-free with the 1st drug?
35% ## Footnote This indicates the initial response rate to the first drug in drug-resistant populations.
194
What percentage of drug-resistant epilepsy patients are seizure-free with the 2nd drug?
11% ## Footnote This reflects the efficacy of the second drug in treating drug-resistant epilepsy.
195
What is the seizure-free rate with the 3rd drug or multiple drugs?
4% ## Footnote This highlights the low success rate of achieving seizure freedom with additional treatments.
196
What percentage of people with epilepsy fail to respond to medication?
30-40% ## Footnote This statistic underscores the prevalence of drug-resistant epilepsy.
197
What are some risks associated with drug-resistant epilepsy (DRE)?
DRE may increase the risk for: * structural damage to brain * comorbidities * psychological, educational, and social consequences * hospitalizations and health-related events * mortality and increased risk of SUDEP ## Footnote SUDEP stands for Sudden Unexpected Death in Epilepsy.
198
What represents 26% of the burden of all neurological disorders?
Epilepsy ## Footnote This indicates the significant impact of epilepsy on public health.
199
What was the burden of chronic epilepsy in women compared to in 2011?
Greater than that of breast cancer ## Footnote This comparison highlights the severity of chronic epilepsy in women.
200
How much greater is DRE in men compared to prostate cancer?
4 times greater ## Footnote This statistic emphasizes the severity of drug-resistant epilepsy in the male population.
201
What are some signs and symptoms of drug-resistant seizures?
Drug-resistant seizures are just one of a number of signs and symptoms, which may include: * further loss of seizure control * structural abnormalities * change in EEG patterns * impairment of cognition * changes in behavior * reduction in social interaction ## Footnote These symptoms can progress over time.
202
True or False: Diagnostic procedures and treatments for epilepsy have no risks.
False ## Footnote Diagnostic procedures, medical, and surgical treatments all carry risks.
203
What is the mortality rate of people with epilepsy compared to the general population?
2-3 times greater ## Footnote This statistic highlights the increased health risks faced by individuals with epilepsy.
204
What percentage of all deaths in epilepsy is accounted for by SUDEP?
7-17% ## Footnote SUDEP stands for Sudden Unexpected Death in Epilepsy.
205
List some causes of death in people with epilepsy.
* SUDEP * Accidents * Suicide * Vascular disease * Pneumonials ## Footnote These causes illustrate the various health challenges faced by epilepsy patients.
206
What is the prevalence of depression in epilepsy patients compared to the general population?
Estimated at 55% ## Footnote This suggests a significant mental health burden among individuals with epilepsy.
207
What is the estimated prevalence of anxiety in epilepsy patients?
Up to 50% ## Footnote This indicates a high level of anxiety disorders in individuals with epilepsy.
208
How much higher is the incidence of suicide in epilepsy patients?
5 to 25 times higher ## Footnote This statistic emphasizes the severe mental health risks associated with epilepsy.
209
What impact do restrictions on independence have on epilepsy patients?
* Self-esteem * Education and/or employment opportunities * Eligibility to drive * Social interactions * Establishing families ## Footnote These factors contribute to the overall quality of life for individuals with epilepsy.
210
What societal issue contributes to the challenges faced by epilepsy patients?
Stigma regarding epilepsy ## Footnote Public education is needed to reduce social isolation caused by this stigma.
211
What can result from drug treatment problems in epilepsy patients?
Dissatisfaction and nonadherence ## Footnote Patients may stop taking medications even if they are effective due to side effects.
212
What is VNS Therapy?
A treatment option for epilepsy with a proven long-term safety and tolerability profile ## Footnote VNS stands for Vagus Nerve Stimulation, and it is an alternative treatment discussed in the module.
213
What is the primary focus of Module 4?
VNS Therapy ## Footnote This module will delve deeper into the details and applications of VNS Therapy in epilepsy treatment.
214
What are the nonpharmacologic treatment options for drug-resistant epilepsy?
Surgery, diet, and neurostimulation ## Footnote These options will be explored in-depth in Section 2 of this module.
215
What is the purpose of the treatment decision algorithm in epilepsy management?
To guide neurologists in treatment choices ## Footnote The algorithm helps in determining the appropriate treatment based on patient-specific factors.
216
What are the two main techniques used in intracranial surgery for epilepsy?
Resection and cutting nerve fibers ## Footnote Resection involves removing the part of the brain that produces seizures, while cutting nerve fibers prevents the spread of seizures.
217
List common types of epilepsy surgeries.
* Lobectomy * Hemispherectomy * Corpus callosotomy * Multiple subpial transection * Laser ablation ## Footnote These surgeries are typically performed to control seizures when medications are ineffective.
218
What dietary methods have been used for the treatment of epilepsy since 500 BC?
Ketogenic Diet, Modified Atkins Diet, Low Glycemic Index Treatment ## Footnote These diets restrict carbohydrate, fat, and protein intake to help manage seizures.
219
What is the role of neurostimulation in treating drug-resistant epilepsy?
To modulate neuronal activity and control seizures ## Footnote Neurostimulation devices provide additional treatment options and may help manage otherwise uncontrolled seizures.
220
When did the first therapeutic brain stimulation efforts begin?
In the early 1950s ## Footnote These efforts were initially focused on psychiatry before being applied to epilepsy treatment.
221
What is vagus nerve stimulation (VNS)?
A neurostimulation technique approved for treating epilepsy ## Footnote VNS has been used for over 25 years to help control seizures.
222
What are the recent developments in neurostimulation for epilepsy?
* Deep brain stimulation (DBS) of the anterior thalamus * Responsive neurostimulation (RNS) ## Footnote DBS targets partial onset seizures, while RNS delivers stimuli to seizure foci in response to detected seizures.
223
True or False: Stimulation devices can cure epilepsy.
False ## Footnote While they help control seizures, stimulation devices do not provide a cure for epilepsy.
224
Fill in the blank: Fasting and other dietary methods for epilepsy treatment have been reported since _______.
500 BC ## Footnote This indicates the long history of dietary approaches in managing epilepsy.
225
What is the primary treatment goal for newly diagnosed epilepsy?
No Seizures ## Footnote This goal focuses on achieving complete seizure control for patients who are newly diagnosed with epilepsy.
226
What is a key treatment goal for drug-resistant epilepsy?
Optimize long-term seizure control ## Footnote This involves finding effective treatments that maintain seizure control over time, especially in patients who do not respond to standard therapies.
227
List the treatment goals for epilepsy management.
* No Seizures * No Side Effects * Maximize quality of life * Minimize side effects * Maximize adherence * Decrease seizure severity/postictal period ## Footnote These goals aim to provide comprehensive care for individuals with epilepsy.
228
True or False: One of the treatment goals for epilepsy is to maximize side effects.
False ## Footnote The goal is to minimize side effects, ensuring a better quality of life for patients.
229
Fill in the blank: The goal of epilepsy treatment is to _______ quality of life.
[maximize] ## Footnote This emphasizes the importance of ensuring that patients lead fulfilling lives despite their condition.
230
What aspect of treatment is emphasized to enhance patient adherence?
Maximize adherence ## Footnote Ensuring that patients follow their treatment plans is crucial for effective epilepsy management.
231
What is the focus of the postictal period in epilepsy treatment?
Decrease seizure severity/postictal period ## Footnote This aims to reduce the impact of seizures on patients' recovery and overall well-being.
232
What is the primary treatment goal for newly diagnosed epilepsy?
No Seizures ## Footnote This goal focuses on achieving complete seizure control for patients who are newly diagnosed with epilepsy.
233
What is a key treatment goal for drug-resistant epilepsy?
Optimize long-term seizure control ## Footnote This involves finding effective treatments that maintain seizure control over time, especially in patients who do not respond to standard therapies.
234
List the treatment goals for epilepsy management.
* No Seizures * No Side Effects * Maximize quality of life * Minimize side effects * Maximize adherence * Decrease seizure severity/postictal period ## Footnote These goals aim to provide comprehensive care for individuals with epilepsy.
235
True or False: One of the treatment goals for epilepsy is to maximize side effects.
False ## Footnote The goal is to minimize side effects, ensuring a better quality of life for patients.
236
Fill in the blank: The goal of epilepsy treatment is to _______ quality of life.
[maximize] ## Footnote This emphasizes the importance of ensuring that patients lead fulfilling lives despite their condition.
237
What aspect of treatment is emphasized to enhance patient adherence?
Maximize adherence ## Footnote Ensuring that patients follow their treatment plans is crucial for effective epilepsy management.
238
What is the focus of the postictal period in epilepsy treatment?
Decrease seizure severity/postictal period ## Footnote This aims to reduce the impact of seizures on patients' recovery and overall well-being.
239
What are the primary goals in treating epilepsy?
* Prevent further seizures * Avoid adverse effects * Improve quality of life * Enable patients to lead active lives
240
What is the first line of treatment for epilepsy?
Antiepileptic drugs (AEDs), either singly or in combination
241
What factors influence AED selection?
* Seizure type * Epilepsy syndrome * Efficacy * Cost * Pharmacokinetic profile * Adverse effects * Patient's related medical conditions
242
What are some common side effects of AEDs?
* Dizziness * Drowsiness * Weight gain
243
What are some serious side effects of AEDs?
* Hepatotoxicity * Nephrolithiasis * Movement disorders * Behavioral disorders
244
What is status epilepticus?
A life-threatening condition with prolonged and/or frequent seizure activity lasting more than 30 minutes without regaining consciousness
245
What is essential for treating status epilepticus?
Immediate treatment with intravenous medications
246
What defines drug-resistant epilepsy (DRE)?
Failure of two appropriately chosen and tolerated AEDs to control seizures for an adequate period
247
What risks are associated with DRE?
* Structural damage to the brain * Comorbidities * Hospitalizations * Health-related events * Increased mortality
248
What did Drs. Kwan and Brodie find in their 30-year study on epilepsy treatment?
Nearly one-third of adults with epilepsy will not achieve remission with drug therapy
249
What treatment options are suggested after two to three AEDs fail?
* Epilepsy surgery * Vagus nerve stimulation (VNS Therapy)
250
What did the RANSOM Study conclude about AED nonadherence?
It is relatively common and is associated with greater healthcare utilization and higher costs for inpatient care and emergency department visits
251
What quality of life issues do patients with epilepsy face?
* Unwanted side effects of medications * Depression * Anxiety * Psychosis * Seizure-related injuries * Suicide
252
How can epilepsy impact a patient's life opportunities?
* Loss of eligibility to drive * Compromised opportunities for education and employment
253
What will be explored in Section 2 of the module?
Nonpharmacologic treatment of epilepsy
254
What are the primary goals in treating epilepsy?
* Prevent further seizures * Avoid adverse effects * Improve quality of life * Enable patients to lead active lives
255
What is the first line of treatment for epilepsy?
Antiepileptic drugs (AEDs), either singly or in combination
256
What factors influence AED selection?
* Seizure type * Epilepsy syndrome * Efficacy * Cost * Pharmacokinetic profile * Adverse effects * Patient's related medical conditions
257
What are some common side effects of AEDs?
* Dizziness * Drowsiness * Weight gain
258
What are some serious side effects of AEDs?
* Hepatotoxicity * Nephrolithiasis * Movement disorders * Behavioral disorders
259
What is status epilepticus?
A life-threatening condition with prolonged and/or frequent seizure activity lasting more than 30 minutes without regaining consciousness
260
What is essential for treating status epilepticus?
Immediate treatment with intravenous medications
261
What defines drug-resistant epilepsy (DRE)?
Failure of two appropriately chosen and tolerated AEDs to control seizures for an adequate period
262
What risks are associated with DRE?
* Structural damage to the brain * Comorbidities * Hospitalizations * Health-related events * Increased mortality
263
What did Drs. Kwan and Brodie find in their 30-year study on epilepsy treatment?
Nearly one-third of adults with epilepsy will not achieve remission with drug therapy
264
What treatment options are suggested after two to three AEDs fail?
* Epilepsy surgery * Vagus nerve stimulation (VNS Therapy)
265
What did the RANSOM Study conclude about AED nonadherence?
It is relatively common and is associated with greater healthcare utilization and higher costs for inpatient care and emergency department visits
266
What quality of life issues do patients with epilepsy face?
* Unwanted side effects of medications * Depression * Anxiety * Psychosis * Seizure-related injuries * Suicide
267
How can epilepsy impact a patient's life opportunities?
* Loss of eligibility to drive * Compromised opportunities for education and employment
268
What will be explored in Section 2 of the module?
Nonpharmacologic treatment of epilepsy
269
What are the two main types of intracranial surgery for epilepsy?
* Resection of the part of the brain that produces seizures * Palliative surgery to cut nerve fibers or connections between nerve cells
270
For how long has intracranial surgery been used as a treatment for epilepsy?
More than half a century
271
What is the only known cure for epilepsy?
Resective surgery, when the lesion causing seizures can be successfully removed
272
Is resective surgery an option for idiopathic epilepsy?
No
273
What are some barriers to pursuing surgical treatment options for epilepsy?
* Patient fear * Irreversibility of intracranial surgery * Concern that risks outweigh benefits * Percentage of failure regarding complete seizure control * Hope for future medical advances * Lack of referrals to Comprehensive Epilepsy Centers * Lack of resources to a center
274
Who are the primary candidates for intracranial surgery?
Patients for whom drug treatment has failed
275
What must neurologists confirm before recommending surgery?
* Confirm drug resistance * Establish that other treatment options have been fully explored * Determine if seizures can be controlled or eliminated by surgery * Delineate the epileptogenic zone to be resected * Ensure surgery can be done safely without compromising neurological or cognitive abilities
276
What type of monitoring is used to localize seizure onset?
EEG long-term monitoring
277
What imaging technique is used with a dedicated 'epilepsy surgery protocol'?
MRI
278
What functional imaging techniques are necessary to delineate a potential epileptogenic zone?
* SPECT * PET * MEG (used in select centers)
279
What type of testing evaluates a patient's pre- and postoperative cognitive functioning?
Neuropsychological testing
280
What is the most common finding in neuropsychological testing for epilepsy patients?
Memory deficit involving the temporal lobe
281
True or False: Intracranial surgery is widely accepted as a first-line treatment for epilepsy.
False
282
Fill in the blank: Candidates for surgery are usually _______.
Adults
283
What is WADA testing?
An intracarotid injection of amobarbital to confirm hemispheric dominance in left-handed and ambidextrous patients ## Footnote This procedure assesses which side of the brain has language and memory functions.
284
What is the purpose of the intracarotid injection during WADA testing?
To anesthetize one side of the brain by injecting medication into the carotid artery.
285
What does intracranial EEG consist of?
Monitoring surface and depth electrodes targeted to specific structures on the surface of the brain.
286
Why is intracranial EEG critical in surgical evaluation?
It helps determine the lateralization of the seizure focus and facilitates the delineation of eloquent cortex.
287
What are invasive electrodes used for in EEG monitoring?
To insert directly onto the surface of the brain when EEG data cannot clearly identify the seizure focus.
288
What is the goal of delineating the eloquent cortex during surgery?
To avoid damaging areas related to motor and speech abilities during resection.
289
Where can EEG recording be completed?
In the operating room or continued in the EMU to capture multiple, typical seizures.
290
Fill in the blank: Sodium _______ is used during WADA testing.
amytal
291
What is the role of dye in angiography?
To visualize blood vessels during the procedure.
292
What is the significance of the left common carotid artery in WADA testing?
It is the site where the amobarbital is injected to test hemispheric dominance.
293
True or False: Intracranial EEG is only performed during surgical procedures.
False
294
What is lobar excision?
Lobar excision is a surgical procedure that may improve seizure control when specific conditions are met.
295
What conditions must be satisfied for lobar excision to have a high probability of improvement?
* EEG monitoring shows consistent seizure onset from the same portion of one frontal or temporal lobe * Other investigations are consistent with this localization * The identified area can be removed safely without permanent cognitive, sensory, or motor deficit
296
What benefit may early epilepsy surgery provide if seizure freedom is not the goal?
Improved quality of life.
297
What is lobectomy?
Lobectomy is the removal of part or all of one lobe of the brain.
298
Who are appropriate candidates for lobectomy?
Patients who experience seizures produced from one lobe consistently.
299
What is the most commonly performed type of intracranial surgery for epilepsy?
Lobectomy.
300
Which lobe is most often involved in lobectomy procedures?
Temporal lobe.
301
What types of seizures are associated with the temporal lobe?
* Simple partial seizures * Complex partial seizures * Secondary generalized seizures
302
What is the seizure freedom rate at 6 months post-temporal lobectomy?
90% seizure-free.
303
What is the seizure freedom rate at 2 years post-temporal lobectomy?
87% seizure-free, with 32% off medication.
304
What is the seizure freedom rate at 12 years post-temporal lobectomy?
70% seizure-free, with 48% off medication.
305
What percentage of patients may still experience auras after temporal lobectomy?
Some patients.
306
What is the overall outcome for temporal lobe surgeries at 12 years post-surgery?
Favorable in over 90% of patients.
307
What percentage of patients will remain on medications long-term after temporal lobe surgery?
Approximately 50%.
308
What does extra-temporal lobe surgery refer to?
Surgery for seizures originating outside the temporal lobe.
309
What percentage of lobectomies does extra-temporal lobe surgery account for?
30-40%.
310
What is the second most common type of epilepsy surgery?
Frontal lobectomy.
311
What is the seizure freedom rate at 6 months post-extra-temporal lobe surgery?
69% seizure-free but remaining on an average of two medications.
312
What is the seizure freedom rate at 2 years post-extra-temporal lobe surgery?
87% seizure-free while continuing on one to two medications.
313
How does the long-term success of extra-temporal lobe surgery compare to temporal lobe surgeries?
Lower than temporal lobe surgeries.
314
What are some complications of lobectomy?
* Partial losses of vision * Motor ability * Memory or speech * Infection * Temporary swelling of the brain
315
What is the incidence of complications in lobectomy patients?
Approximately four out of 100 patients.
316
What is hemispherectomy?
Removal of all or almost all of one hemisphere of the brain
317
What condition is hemispherectomy particularly reserved for?
Rasmussen's encephalitis
318
What effect does Rasmussen's encephalitis have on the brain?
Affects an entire hemisphere and causes severe seizures
319
What is the primary goal of hemispherectomy surgery?
Reduce the frequency and severity of seizures
320
What percentage of patients achieve seizure freedom with hemispherectomy?
Upwards to 90%
321
What limits surgical treatment for epilepsy?
Location of the lesions and associated morbidity or mortality
322
What is MRI-guided laser ablation used for?
Treating deep-seated lesions and lesions in eloquent cortex
323
What does Laser Interstitial Thermal Therapy (LITT) utilize?
A laser to produce precise and minimal heat to the lesion or targeted tissue
324
How long does a typical laser treatment session last?
A few minutes
325
What imaging technique is used during laser ablation?
MR imaging
326
What have studies found regarding long-term effects of hemispherectomy on cognitive functions?
No long-term effects on memory, personality, and minimal changes in overall cognitive functioning
327
What happens to the remaining side of the brain after hemispherectomy in children?
Takes over many functions of the resected hemisphere
328
What is a common consequence for patients after hemispherectomy?
Weakness on the opposite side of the body
329
List some epilepsy applications for laser ablation
* Deep brain lesions * Seizures that start in a focal area of the brain * Patients who have had past epilepsy surgery * Failed medical management of seizures * Focal cortical dysplasia * Mesial temporal lobe epilepsy * Tumors that are too large to remove
330
What is laser ablation?
A minimally-invasive technique using real-time MRI to guide a laser to destroy affected tissue ## Footnote The goal is to destroy the seizure focus or tumor with little damage to surrounding tissue.
331
What is the primary benefit of laser ablation compared to open procedures?
Reduced hospital stays due to its minimally invasive nature ## Footnote This technique is relatively new, and long-term results are not well established.
332
What percentage of patients with epilepsy may become seizure-free after laser ablation?
Nearly half ## Footnote Some patients may achieve this within a week of the procedure.
333
What is the one-year seizure freedom rate for laser ablation compared to traditional resective surgery?
Approximately 80% ## Footnote Seizure freedom rates are comparable to those of traditional surgery.
334
What is the relationship between laser ablation and risk compared to open surgery?
LITT has approximately the same success rate but carries less risk ## Footnote Some patients may still have seizures, but they tend to be less severe.
335
What is the purpose of a corpus callosotomy?
To sever the corpus callosum and interrupt the spread of seizures between hemispheres ## Footnote This procedure seeks to eliminate the interhemispheric pathway of epileptic activity.
336
What types of seizures are appropriate candidates for corpus callosotomy?
Tonic/atonic seizures or seizures with bifrontal onsets ## Footnote Severing the corpus callosum can reduce the severity of seizures.
337
What is multiple subpial transection (MST)?
A surgical technique that partially cuts the connections of the epileptic focus without resecting it ## Footnote This is performed when the lesion is near eloquent cortex areas.
338
What is the typical outcome for patients undergoing multiple subpial transection?
Temporary seizure reduction, but they generally do not become seizure-free ## Footnote MST is suitable for lesions in critical brain areas responsible for vital functions.
339
Fill in the blank: The corpus callosum acts as a bridge between the _______.
left and right hemispheres of the brain
340
True or False: Seizures generally stop completely after a corpus callosotomy.
False ## Footnote Seizures typically become less severe but do not completely stop.
341
What is the most common complication after epilepsy surgery?
Infection ## Footnote Infection is followed by intracranial hematoma or hemorrhage.
342
What percentage of patients experience overall neurological complications after epilepsy surgery?
Approximately 3.2% ## Footnote The neurological morbidity rate is higher in multilobar resections.
343
What is the neurological morbidity rate for multilobar resections?
Approximately 14.6% ## Footnote This is significantly higher compared to other types of resections.
344
What is the neurological morbidity rate for temporal resections?
1.1% ## Footnote Temporal resections have the least morbidity.
345
List some other complications of epilepsy surgery.
* Transient headaches * Loss of motor function * Seizure recurrence * Memory loss * Depression and anxiety ## Footnote These complications can vary in severity.
346
What percentage of patients remained seizure-free 1 year after epilepsy surgery, according to the Cleveland Clinic study?
76% ## Footnote The percentage is slightly different for adult and pediatric epilepsy.
347
What percentage of adult epilepsy patients remained seizure-free 5 years after surgery?
56% ## Footnote This reflects the long-term outcomes of adult patients.
348
True or False: 50% of pediatric epilepsy patients remained seizure-free 10 years after surgery.
True ## Footnote This statistic indicates a similar outcome for pediatric patients as well.
349
Fill in the blank: Approximately _____ of patients remained seizure-free more than a decade following surgery.
50% ## Footnote This statistic includes both adult and pediatric patients.
350
What was the percentage of seizure-free patients at the 12-year mark after surgery?
44% ## Footnote This shows a gradual decline in seizure-free rates over time.
351
What historical dietary methods have been reported for the treatment of epilepsy?
Fasting and other dietary methods since 500 BC ## Footnote This includes early observations of seizure improvement after fasting.
352
Who proposed the idea of maintaining the benefits of fasting through diet?
Dr. Wilder of the Mayo Clinic ## Footnote He proposed that ketonemia could mimic fasting benefits.
353
What is the primary purpose of the ketogenic diet (KD)?
Treatment of epilepsy ## Footnote The KD is particularly effective for drug-resistant epilepsy (DRE).
354
What is the typical macronutrient composition of the ketogenic diet?
75% fat, 25% carbohydrates and proteins combined ## Footnote This is in contrast to the traditional American diet of 55% carbohydrates.
355
What is the most restrictive fat-to-carbohydrate/protein ratio in the ketogenic diet?
4:1 ## Footnote A 3:1 ratio is also commonly used.
356
What foods are excluded from the ketogenic diet?
Pasta, breads, and starchy vegetables ## Footnote These are restricted to maintain low carbohydrate intake.
357
What types of foods are approved for the ketogenic diet?
Eggs, bacon, lobster, butter, cream, and small portions of fruits and vegetables ## Footnote These foods align with the high-fat, low-carbohydrate requirement.
358
What is the initial step in implementing the ketogenic diet?
An initial fast of 24-48 hours ## Footnote This is followed by gradually introducing the diet's macronutrient ratios.
359
Why is the hospital setting important during the initial implementation of the ketogenic diet?
To monitor side effects like low blood sugar, metabolic acidosis, and vomiting ## Footnote These conditions can be life-threatening if not managed properly.
360
What role does a skilled KD dietitian play in the ketogenic diet?
Perform diet calculation and educate on diet maintenance ## Footnote They help create individualized meal plans for patients.
361
How can families calculate individualized meal plans for the ketogenic diet?
Using online Keto-calculator tools approved by the KD dietitian ## Footnote This aids in achieving precise nutritional goals.
362
What percentage of patients on the ketogenic diet experience a dramatic decrease in seizure frequency?
Up to one-third of patients ## Footnote This statistic is based on numerous case studies over 80 years.
363
What alternative dietary therapies were developed due to challenges with adherence to the KD?
Modified Atkins Diet (MAD) and low glycemic index treatment (LGIT) ## Footnote These alternatives aim to provide more flexible options for patients.
364
True or False: The ketogenic diet is only recommended for adults.
False ## Footnote It is generally recommended for children, but there are reports of efficacy in adults.
365
What is the protein percentage in a Regular Diet?
20%
366
What percentage of carbohydrates is in a Regular Diet?
50%
367
What is the fat percentage in a Regular Diet?
30%
368
What is the protein percentage in a Ketogenic Diet?
6%
369
What percentage of carbohydrates is in a Ketogenic Diet?
4%
370
What is the fat percentage in a Ketogenic Diet?
90%
371
What is the protein percentage in a Modified Atkins Diet?
25%
372
What percentage of carbohydrates is in a Modified Atkins Diet?
10%
373
What is the fat percentage in a Modified Atkins Diet?
65%
374
What is the protein percentage in a Low Glycemic Index Treatment?
30%
375
What percentage of carbohydrates is in a Low Glycemic Index Treatment?
10%
376
What is the fat percentage in a Low Glycemic Index Treatment?
60%
377
What percentage of patients achieve a 50% reduction in seizures with diet therapy?
Approximately 50% ## Footnote This statistic highlights the effectiveness of dietary interventions in managing seizures.
378
What percentage of patients reach a greater than 90% reduction in seizures with diet therapy?
20% ## Footnote This indicates a significant response rate for some patients undergoing dietary treatment.
379
Which diet has been the most studied in children for seizure reduction?
Classic Ketogenic Diet (KD) ## Footnote The classic KD is often the focus of research regarding dietary treatment for epilepsy.
380
What are the two alternative diets noted to have similar efficacy rates as the KD?
Modified Atkins Diet (MAD) and Low Glycemic Index Treatment (LGIT) ## Footnote These diets offer alternatives to the classic KD with comparable results.
381
What seizure type is diet therapy most efficacious for?
Simple partial seizures ## Footnote This suggests that certain seizure types may respond better to dietary interventions.
382
Why are dietary treatments used more frequently in children with DRE than in adults?
Children tend to extract and utilize ketones from blood more efficiently ## Footnote This metabolic difference may explain the higher prevalence of diet therapy in pediatric patients.
383
What is a common challenge faced when adhering to dietary treatments?
Restrictive nature of the diets ## Footnote Families often struggle to maintain adherence due to the limitations imposed by the diet.
384
What are some common gastrointestinal symptoms associated with diet therapy?
* Vomiting * Constipation * Diarrhea ## Footnote These symptoms can affect 12-50% of children on dietary treatments.
385
What is the risk percentage of renal calculi occurring in patients on diet therapy?
3-5% ## Footnote This indicates a low incidence of kidney stones as a side effect of dietary treatment.
386
What is Vagus Nerve Stimulation (VNS) Therapy designed to do?
Control seizures by sending regular, mild pulses of electrical energy to the brain ## Footnote VNS is a neuromodulation technique used as an adjunctive therapy.
387
When was VNS Therapy approved for the treatment of epilepsy?
1997 ## Footnote This marks the introduction of VNS as a treatment option in epilepsy management.
388
What is the primary indication for VNS Therapy?
Adjunctive therapy in reducing the frequency of seizures in adults and adolescents over age 12 with refractory partial onset seizures ## Footnote VNS is not a first-line treatment but is used when other treatments fail.
389
How does VNS Therapy control seizures?
By sending mild pulses to the left vagus nerve at regular intervals ## Footnote This continuous stimulation aims to modulate seizure activity.
390
What is the duration of the outpatient procedure required for VNS implantation?
1-2 hours ## Footnote This procedure is minimally invasive and typically performed on an outpatient basis.
391
What type of seizures does Responsive Neurostimulation (RNS) target?
Uncontrolled partial onset seizures ## Footnote RNS provides stimulation in response to detected abnormal brain signals.
392
What does Deep Brain Stimulation (DBS) involve?
Implanting electrodes into specific areas of the brain and stimulating these areas with small regular electrical impulses ## Footnote DBS is another approach to managing refractory epilepsy.
393
What is the purpose of the RNS device?
To detect seizures at onset and stimulate at the seizure focus to abort seizure propagation. ## Footnote RNS stands for Responsive Neurostimulation, which utilizes electrodes to monitor brain activity.
394
What types of electrodes does the RNS use?
Subdural and depth electrodes. ## Footnote These electrodes are crucial for recording electrographic activity in the brain.
395
When was the RNS System approved for use in the U.S.?
In 2013. ## Footnote This marked a significant advancement in epilepsy treatment technology.
396
What type of seizures is the RNS designed to treat?
Partial onset seizures. ## Footnote It is specifically designed for patients with localized seizure foci.
397
What age group is the RNS System intended for?
Individuals 18 years of age or older. ## Footnote The device is not approved for younger individuals.
398
What conditions must a patient meet to qualify for RNS therapy?
Must be refractory to two or more antiepileptic medications and have frequent, disabling seizures. ## Footnote This includes various types of partial seizures.
399
What is the first step in the RNS implant procedure?
Pre-surgical evaluation to identify the location of seizure origin. ## Footnote This step is critical for effective placement of the device.
400
What is involved in the lead implant step of the RNS procedure?
Patient is placed in a Mayfield skull cap, followed by an incision and burr hole for lead insertion. ## Footnote A second lead may also be inserted during this step.
401
What happens during the tunnel leads step?
Leads are tunneled under the scalp to exit the burr hole. ## Footnote This ensures that the leads are properly positioned for the neurostimulator.
402
What is done during the neurostimulator implant step?
A scalp incision is made, a craniectomy template is traced, and the neurostimulator is secured in the craniectomy. ## Footnote This step is crucial for the device's stability.
403
What is the final step in the RNS implant procedure?
Program the neurostimulator to stimulate upon detection of seizure propagation. ## Footnote Proper programming is essential for the device's functionality.
404
What are some complications of Responsive Neurostimulation (RNS)?
Increased depression and anxiety, infection, intracranial hemorrhage, pain at the implant site, paralysis, skin erosion ## Footnote Skin erosion may occur particularly if the implanted products protrude above the skull surface.
405
What percentage of participants experienced Serious Adverse Events (SAE) with RNS?
2.5% ## Footnote SAE includes implant site infection and intracranial hemorrhage among others.
406
What percentage of RNS participants experienced implant site infection?
9.4% ## Footnote This is part of the Serious Adverse Events reported.
407
What percentage of RNS participants experienced intracranial hemorrhage?
4.7% ## Footnote This is part of the Serious Adverse Events reported.
408
What were the increases in seizure-related events reported in RNS trials?
* 7.8% increase in complex partial seizures * 5.9% increase in GTC seizures * 3.1% non-convulsive status * 2.7% convulsive status ## Footnote GTC stands for generalized tonic-clonic.
409
How many deaths were reported in the RNS clinical trials?
11 deaths ## Footnote Causes included suicides, status-related deaths, and SUDEP.
410
What is the SUDEP rate reported in the RNS clinical trials?
2.3% ## Footnote SUDEP stands for Sudden Unexpected Death in Epilepsy.
411
What was the median seizure reduction observed in the long-term trials of RNS?
80% ## Footnote This is the highest median seizure reduction across the years reported.
412
What were the participant numbers in the 2-year randomized blinded controlled safety and efficacy study?
191 participants ## Footnote This study was part of the long-term efficacy trials.
413
Fill in the blank: The effects of long-term stimulation with RNS are _______.
[not known] ## Footnote This indicates that long-term effects have not been fully assessed.
414
What types of improvements were reported in adults undergoing RNS treatment?
* Long-term seizure reduction * Quality of life improvements * Benefits in language and memory ## Footnote These improvements were noted in clinical trials.
415
What cognitive effects were observed in patients treated with the RNS® System?
No adverse cognitive effects.
416
What significant improvements were noted in patients with neocortical onset seizures?
Statistically significant improvements in naming.
417
What significant improvements were observed in patients with mesial temporal onset seizures?
Statistically significant improvements in verbal memory.
418
What is the relationship between RNS treatment and cognitive decline?
RNS treatment has not been associated with cognitive decline.
419
How does RNS treatment affect quality of life and mood?
Does not adversely affect quality of life or mood and may improve QOL.
420
What tool is mentioned for measuring quality of life in patients?
QOLIE-89.
421
What are the adverse events associated with RNS treatment?
* implant infection - 3.5% * death - 4.3% * intracranial hemorrhage - 2.7% * increased seizures - 7.8%
422
Fill in the blank: Patients treated with the RNS® System showed _______ cognitive effects.
no adverse
423
True or False: RNS treatment is associated with cognitive decline.
False.
424
What was the improvement in cognitive function based on seizure onset region?
Dependent upon region of seizure onset.
425
List the cognitive functions measured in the study.
* Boston Naming Test * AVLT Learning
426
What percentage of patients experienced increased seizures as an adverse event?
7.8%
427
What is deep brain stimulation (DBS)?
A neuro-modulation therapy involving the delivery of electrical impulses to specific regions of the brain.
428
How is stimulation delivered in DBS?
Via implanted leads connected by an extension to an implantable pulse generator.
429
What is the median seizure reduction rate at 1 year of DBS treatment?
44%
430
What is the median seizure reduction rate at 6 years of DBS treatment?
66%
431
What type of data can be downloaded for neurologist review in DBS?
EEG data capturing: * Real time seizure diary * Event lateralization
432
What improvements are seen in patients receiving DBS?
Improvements in quality of life (QOL) and cognition independent of seizure control.
433
Are previous procedures detrimental to DBS outcomes?
No, previous procedures are not detrimental to outcomes.
434
What patients can benefit from DBS after prior treatments?
Patients with prior VNS Therapy or resective surgery.
435
What customization options are available for DBS therapy?
Multiple programs possible and additional device insights with patient programmer.
436
What is the rationale for DBS of the thalamus?
The thalamus serves as a relay station inhibiting signals that may cause seizures.
437
Which specific nucleus of the thalamus is implicated in seizure spread?
The anterior nucleus of the thalamus (ANT).
438
What has stimulation of the ANT been shown to do?
Reduce or inhibit seizures.
439
For which conditions has DBS been available for treatment for several years?
Parkinson's tremor and dystonia.
440
When was DBS approved in Europe for the treatment of epilepsy?
Recently.
441
Fill in the blank: The median seizure reduction for DBS is _______ at 1 year.
44%
442
True or False: Improvements in QOL and cognition from DBS occur only with seizure control.
False
443
What is deep brain stimulation (DBS)?
A neuro-modulation therapy involving the delivery of electrical impulses to specific regions of the brain.
444
How is stimulation delivered in DBS?
Via implanted leads connected by an extension to an implantable pulse generator.
445
What is the median seizure reduction rate at 1 year of DBS treatment?
44%
446
What is the median seizure reduction rate at 6 years of DBS treatment?
66%
447
What type of data can be downloaded for neurologist review in DBS?
EEG data capturing: * Real time seizure diary * Event lateralization
448
What improvements are seen in patients receiving DBS?
Improvements in quality of life (QOL) and cognition independent of seizure control.
449
Are previous procedures detrimental to DBS outcomes?
No, previous procedures are not detrimental to outcomes.
450
What patients can benefit from DBS after prior treatments?
Patients with prior VNS Therapy or resective surgery.
451
What customization options are available for DBS therapy?
Multiple programs possible and additional device insights with patient programmer.
452
What is the rationale for DBS of the thalamus?
The thalamus serves as a relay station inhibiting signals that may cause seizures.
453
Which specific nucleus of the thalamus is implicated in seizure spread?
The anterior nucleus of the thalamus (ANT).
454
What has stimulation of the ANT been shown to do?
Reduce or inhibit seizures.
455
For which conditions has DBS been available for treatment for several years?
Parkinson's tremor and dystonia.
456
When was DBS approved in Europe for the treatment of epilepsy?
Recently.
457
Fill in the blank: The median seizure reduction for DBS is _______ at 1 year.
44%
458
True or False: Improvements in QOL and cognition from DBS occur only with seizure control.
False
459
What is the percentage of serious adverse events (SAEs) at 5 years for DBS?
34% ## Footnote Serious adverse events include various complications associated with deep brain stimulation.
460
What percentage of patients experienced depression events as a serious adverse event with DBS?
37.3% ## Footnote This highlights the mental health risks associated with DBS.
461
What percentage of patients reported suicidal ideation as a serious adverse event with DBS?
11.8% ## Footnote Suicidal ideation is a significant concern in patients undergoing this procedure.
462
What is the percentage of memory impairment reported as a serious adverse event with DBS?
27% ## Footnote Memory impairment can affect quality of life post-surgery.
463
What is the percentage of patients who experienced status epilepticus as a seizure-related adverse event?
6.4% ## Footnote Status epilepticus is a life-threatening condition requiring immediate medical attention.
464
What percentage of patients experienced an increase in complex partial seizures after DBS?
9.3% ## Footnote This increase can complicate the overall treatment plan.
465
What percentage of patients experienced an increase in simple partial seizures after DBS?
5.6% ## Footnote Increased seizure frequency can be a significant concern following surgery.
466
How many deaths occurred as a result of DBS according to the data?
7 deaths ## Footnote This includes various causes related to the procedure.
467
What is the SUDEP rate associated with DBS?
2.9:1000 ## Footnote SUDEP stands for Sudden Unexpected Death in Epilepsy.
468
What are the steps involved in the surgical procedure for DBS placement?
* Stereotactic Frame and Imaging * Surgical Planning * Preparing Lead Placement * Lead Placement * Implantation of IPG ## Footnote Each step is critical for the success of the surgery.
469
What are the components of the Stereotactic Frame and Imaging step?
* Stereotactic frame placement * Imaging with frame ## Footnote Accurate imaging is essential for precise lead placement.
470
What does the Preparing Lead Placement step involve?
* Stereotactic arc fixation * Incision and burr hole through skull ## Footnote This step is crucial to access the brain for lead placement.
471
What is included in the Lead Placement step?
* Physiological confirmation of target (if performed) * Lead placement * Macrostimulation clinical testing (if performed) * Lead fixation * Confirmation of lead location (if performed) ## Footnote Ensuring correct lead placement can significantly impact treatment efficacy.
472
What does the Implantation of IPG step entail?
* IPG placement ## Footnote The IPG (Implantable Pulse Generator) is crucial for delivering stimulation.
473
What was the purpose of the SANTE study?
To prove the safety and efficacy of DBS for the treatment of DRE ## Footnote SANTE stands for Stimulation of the Anterior Nucleus of the Thalamus for Epilepsy.
474
What type of study design was used in the SANTE trial?
Multi-center, double blind, randomized study
475
What age group was included in the SANTE study?
Patients aged 18-65 years
476
How many medications had the patients failed before participating in the SANTE trial?
At least three medications
477
What was the median seizure reduction at one month in the SANTE trial?
34% median reduction in seizures
478
What was the median seizure reduction at three months in the SANTE trial?
40.3% reduction in seizures
479
What was the significance of the seizure reduction at three months in relation to the control group?
Clinically significant above the control group
480
What is the source of the long-term follow-up study mentioned?
Published in the Journal of Neurology in 2015
481
When did the long-term follow-up begin after device implantation?
13 months after device implantation
482
How was seizure frequency determined in the long-term follow-up study?
Using daily seizure diaries
483
What was the primary objective of the long-term follow-up study?
To report long-term efficacy and safety of DBS for the treatment of epilepsy
484
Fill in the blank: The SANTE trial showed a _______ median reduction in seizures at one month.
34%
485
Fill in the blank: The SANTE trial showed a _______ median reduction in seizures at three months.
40.3%
486
True or False: The SANTE study included patients with generalized seizures.
False
487
What was the sample size of the active group in the SANTE trial?
n=108 patients with ≥270 diary days
488
What did the five-year follow-up study aim to assess?
Long-term efficacy and safety of DBS for epilepsy
489
What was the median seizure reduction from baseline at one year?
41%
490
What was the median seizure reduction from baseline at five years?
Nearly 70%
491
What significant improvements were observed in neuropsych testing at five years?
Attention, executive function, depression, anxiety, and cognitive functioning
492
What percentage of patients had a clinically significant QOLIE-31 improvement from baseline at five years?
48%
493
What percentage of the study group had a clinically significant long-term seizure severity improvement from baseline at five years?
Nearly half
494
What were the most common adverse events reported in the study?
Depression and memory impairment
495
What percentage of patients experienced depression as an adverse event?
14.8%
496
What is the seizure-free rate at five years for patients?
10% (11/109)
497
What percentage reported at least one seizure-free interval of six months or more?
16% (17/109)
498
What is a key strength of DBS in comparison to VNS?
Superior speed of dosing compared with VNS
499
What is the advantage of the first dose in DBS treatment?
First dose is therapeutic
500
Are previous procedures detrimental to outcomes in DBS?
No, previous procedures are not detrimental
501
What is a benefit of DBS for patients with prior VNS Therapy or resective surgery?
Efficacious for patients with prior therapies
502
What kind of control do patients have over their DBS therapy?
More patient control of therapy
503
What features allow for patient control in DBS?
Multiple programs possible and additional device insights with patient programmer
504
Fill in the blank: The median seizure reduction from baseline for patients with ≥70 days of diary was _______.
80%
505
True or False: The study showed statistically significant improvements in neuropsych testing in several domains at 5 years.
True
506
What was the seizure-free duration for at least 6 months in the 5 years after implant?
Percentage increased over time, with specific rates mentioned for different intervals
507
What are the types of epilepsy surgery?
Lobectomy, hemispherectomy, corpus callosotomy, multiple subpial transection, laser ablation
508
What is the only known cure for epilepsy?
Resective surgery when the lesion or part of the brain causing seizures can be resected
509
Who are the primary candidates for intracranial surgery?
Patients for whom drug treatment has failed
510
What evaluations are included in the assessment for epilepsy surgery candidates?
Review of seizure history, AED trial, EEG monitoring, MRI, functional MRI, functional imaging, neuropsychological testing, WADA testing
511
When have fasting and dietary methods for epilepsy treatment been reported since?
As far back as 500 BC
512
What do diet therapies for epilepsy aim to change?
The body's metabolism through varying ratios of fat, carbohydrates, and proteins
513
What are some examples of dietary therapies for epilepsy?
Ketogenic diet, Modified Atkins Diet, Low Glycemic Index Treatment
514
What is VNS Therapy designed to do?
Prevent seizures by sending regular, mild pulses of electrical energy to the brain via the vagus nerve
515
How does the RNS System treat uncontrolled partial onset seizures?
Automatically monitors brain signals and provides stimulation to abnormal electrical events as needed
516
What does DBS therapy involve?
Implanting electrodes into specific areas of the brain and stimulating these areas with small regular electrical impulses
517
Fill in the blank: The ketogenic diet, Modified Atkins Diet, and Low Glycemic Index Treatment are examples of _______.
[diet therapies for epilepsy]
518
What are antiepileptic drugs (AEDs)?
Drugs used to treat or prevent epileptic convulsions ## Footnote AEDs are essential in managing epilepsy and preventing seizures.
519
Define bifrontal epilepsy.
Epilepsy arising from the frontal lobes, in both the left and right hemispheres ## Footnote This type of epilepsy can affect behavior and motor function.
520
What does contralateral mean?
Pertaining to, situated on, or coordinated with the opposite side ## Footnote Often used in neurological contexts to describe effects or conditions.
521
What is cranial osteomyelitis?
Local or generalized infection of bone and bone marrow, usually caused by bacteria ## Footnote Can occur due to trauma, surgery, or infections spreading through the bloodstream.
522
Define dystonia.
Involuntary, often acute movement and prolonged contraction of one or more muscles ## Footnote Results in twisting body motions, tremor, and abnormal posture.
523
What is intracranial surgery?
Surgery that is done within the cranium or the skull ## Footnote This type of surgery may be performed for various neurological conditions.
524
What does ketonemia refer to?
The presence of an abnormally high concentration of ketone bodies in the blood ## Footnote Often associated with diabetic ketoacidosis or prolonged fasting.
525
Define mesial temporal lobe epilepsy.
Condition characterized by hippocampal sclerosis with complex partial seizures ## Footnote Often results in postictal confusion and typically has an aura.
526
What is metabolic acidosis?
A pH imbalance where the body has accumulated too much acid ## Footnote Occurs when there is not enough bicarbonate to neutralize the acid.
527
What does palliative mean?
Serving to reduce pain without treating its underlying cause ## Footnote Palliative care focuses on improving quality of life.
528
Define pharmacokinetic.
The study of the time course of drug absorption, distribution, metabolism, and excretion ## Footnote Important for understanding how drugs affect the body over time.
529
What is the epileptogenic zone?
A cortical region of the brain that, when stimulated, produces spontaneous seizure or aura ## Footnote Identifying this zone is crucial for epilepsy treatment.
530
What are focal onset seizures?
Manifestations of abnormal epileptic firing of brain cells in a localized area of the brain ## Footnote Can evolve into generalized seizures in some cases.
531
Define focal cortical dysplasia.
Congenital abnormality of brain development where neurons fail to migrate properly ## Footnote This condition can lead to epilepsy.
532
What is polypharmacy?
Two or more drugs prescribed and meant to be taken simultaneously ## Footnote Common in managing chronic conditions, including epilepsy.
533
What does QOLIE - 31 stand for?
Survey of health-related quality of life for adults with epilepsy ## Footnote Completed by the patient, consisting of 31 questions covering various health aspects.
534
Define glycemic index.
A numerical index given to carbohydrate-rich food based on blood glucose increase ## Footnote Helps in managing diabetes and understanding food impacts on blood sugar.
535
What is resective surgery?
The excision of all or part of an organ or tissue ## Footnote Often performed to treat epilepsy or tumors.
536
What does synergistic mean in pharmacology?
Two drugs working together to create an effect greater than the sum of their individual effects ## Footnote Important for enhancing treatment efficacy.
537
Define hypoxia.
Deficiency in the amount of oxygen reaching the tissues ## Footnote Can lead to serious health issues if not addressed.
538
What is the definition of drug-resistant epilepsy?
Consensus proposal by the ad hoc task force of the ILAE Commission on Therapeutic Strategies. ## Footnote Kwan P, Arzimanoglou A, Berg AT, et al. proposed this definition in 2010.
539
What is the main focus of the Glasgow story regarding refractory epilepsy?
The road to refractory epilepsy as discussed by Brodie MJ. ## Footnote Brodie, MJ. Road to refractory epilepsy: the Glasgow story. Epilepsia. 2013.
540
What is the impact of nonadherence to antiepileptic drugs?
Increased health care utilization and costs. ## Footnote Findings from the RANSOM study.
541
What are some side effects of antiepileptics?
Potential side effects include: * Drowsiness * Dizziness * Nausea * Weight gain * Mood changes ## Footnote Walia KS, Khan EA, Ko DH, et al. provided a review of these side effects.
542
True or False: Epilepsy can affect reproductive and sexual function in men.
True. ## Footnote Montouris G, Morris GL III discussed this in their 2005 study.
543
Fill in the blank: The staged approach to epilepsy management was proposed by _______.
[Brodie MJ and Kwan P]. ## Footnote This approach was detailed in Neurology, 2002.
544
What are the consequences of refractory epilepsy?
Consequences include: * Increased seizure frequency * Quality of life impairment * Psychological issues ## Footnote Laxer KD, Trinka H, Hirsch LJ, et al. explored these consequences in their 2014 publication.
545
What is the public health burden associated with sudden unexpected death in epilepsy?
Significant public health concern. ## Footnote Discussed by Thurman DJ, Hesdorffer DC, French, JA in 2014.
546
What is the primary focus of the article by Goldenberg MM?
Overview of drugs used for epilepsy and seizures: etiology, diagnosis, and treatment. ## Footnote Published in Pharmacy and Therapeutics, 2010.
547
What are the statistics related to epilepsy?
Epilepsy statistics include incidence rates, prevalence, and demographics. ## Footnote Shafer PO, Sirven JI provided insights into these statistics.
548
What is one key aspect of epilepsy in childhood?
Epilepsy can present differently in children compared to adults. ## Footnote Referenced in the resource on epilepsy in childhood.
549
Fill in the blank: The effects of epilepsy on pregnancy were discussed in a resource updated in _______.
[2004 Mar]. ## Footnote This resource is available on epilepsy.com.
550
What is the focus of Gildenberg PL's 2005 article?
Evolution of neuromodulation ## Footnote Discusses the advancements in neuromodulation techniques over time.
551
What does Ben-Menachem E's 2012 article discuss?
Neurostimulation-past, present, and beyond ## Footnote Examines the history and future prospects of neurostimulation.
552
What is the MNI approach in epilepsy surgery?
Techniques in epilepsy surgery ## Footnote Detailed in the work by Oliver A et al. published by Cambridge Press.
553
What is the key to improving quality of life in epilepsy surgery according to Cascin GD?
The surgery outcome ## Footnote Emphasizes that successful surgical outcomes significantly enhance quality of life.
554
What long-term risks are associated with temporal lobectomy?
Late recurrence and risks for seizure recurrence ## Footnote Explored by McIntosh AM et al. in their 2004 study.
555
What is a primary concern regarding temporal lobectomy according to the Epilepsy Foundation?
Benefits and risks of temporal lobectomy ## Footnote Provides an overview of the advantages and potential complications of the procedure.
556
What does the 2008 study by Lettori DI et al. focus on?
Early hemispherectomy in catastrophic epilepsy ## Footnote Analyzes neuro-cognitive and epileptic long-term follow-up results.
557
What does Hawasli AH's 2013 article present?
Magnetic resonance imaging-guided focused laser interstitial thermal therapy ## Footnote Discusses a single-institution series of treatments for intracranial lesions.
558
What is the focus of Waseem H's 2015 article?
Laser ablation therapy for medically resistant mesial temporal lobe epilepsy ## Footnote Evaluates the effectiveness of this therapy in patients over age 50.
559
What is the outcome discussed in Park MS's 2013 article?
Outcome of corpus callosotomy in adults ## Footnote Investigates the results and implications of this surgical procedure.
560
What historical aspect does Wheless JW's 2008 article cover?
History of the ketogenic diet ## Footnote Reviews the development and application of the ketogenic diet in epilepsy treatment.
561
What does Bailey EE et al. discuss regarding diet?
The use of diet in the treatment of epilepsy ## Footnote Explores dietary interventions as therapeutic options for epilepsy management.
562
What is the effectiveness of the modified Atkins diet according to Kossoff EH et al.?
Effective for the treatment of intractable pediatric epilepsy ## Footnote Demonstrates positive outcomes for children with difficult-to-treat epilepsy.
563
What is the focus of Gildenberg PL's 2005 article?
Evolution of neuromodulation ## Footnote Discusses the advancements in neuromodulation techniques over time.
564
What does Ben-Menachem E's 2012 article discuss?
Neurostimulation-past, present, and beyond ## Footnote Examines the history and future prospects of neurostimulation.
565
What is the MNI approach in epilepsy surgery?
Techniques in epilepsy surgery ## Footnote Detailed in the work by Oliver A et al. published by Cambridge Press.
566
What is the key to improving quality of life in epilepsy surgery according to Cascin GD?
The surgery outcome ## Footnote Emphasizes that successful surgical outcomes significantly enhance quality of life.
567
What long-term risks are associated with temporal lobectomy?
Late recurrence and risks for seizure recurrence ## Footnote Explored by McIntosh AM et al. in their 2004 study.
568
What is a primary concern regarding temporal lobectomy according to the Epilepsy Foundation?
Benefits and risks of temporal lobectomy ## Footnote Provides an overview of the advantages and potential complications of the procedure.
569
What does the 2008 study by Lettori DI et al. focus on?
Early hemispherectomy in catastrophic epilepsy ## Footnote Analyzes neuro-cognitive and epileptic long-term follow-up results.
570
What does Hawasli AH's 2013 article present?
Magnetic resonance imaging-guided focused laser interstitial thermal therapy ## Footnote Discusses a single-institution series of treatments for intracranial lesions.
571
What is the focus of Waseem H's 2015 article?
Laser ablation therapy for medically resistant mesial temporal lobe epilepsy ## Footnote Evaluates the effectiveness of this therapy in patients over age 50.
572
What is the outcome discussed in Park MS's 2013 article?
Outcome of corpus callosotomy in adults ## Footnote Investigates the results and implications of this surgical procedure.
573
What historical aspect does Wheless JW's 2008 article cover?
History of the ketogenic diet ## Footnote Reviews the development and application of the ketogenic diet in epilepsy treatment.
574
What does Bailey EE et al. discuss regarding diet?
The use of diet in the treatment of epilepsy ## Footnote Explores dietary interventions as therapeutic options for epilepsy management.
575
What is the effectiveness of the modified Atkins diet according to Kossoff EH et al.?
Effective for the treatment of intractable pediatric epilepsy ## Footnote Demonstrates positive outcomes for children with difficult-to-treat epilepsy.
576
What is the focus of the study by Pfeifer et al. in 2008?
Low glycemic index treatment: implementation and new insights into efficacy ## Footnote This study discusses the efficacy of low glycemic index diets in the treatment of epilepsy.
577
What clinical experience is reported by Valencia et al. in 2002?
General anesthesia and the ketogenic diet: clinical experience in nine patients ## Footnote This study explores the use of ketogenic diets in patients undergoing general anesthesia.
578
What does the review by Payne et al. in 2011 cover?
The ketogenic and related diets in adolescents and adults ## Footnote This review provides insights into the effectiveness of ketogenic diets for epilepsy in older populations.
579
What are the findings of Loring et al. in 2015 regarding neuropsychological outcomes?
Differential neuropsychological outcomes following targeted responsive neurostimulation for partial-onset epilepsy ## Footnote This study examines the cognitive effects of targeted neurostimulation in epilepsy treatment.
580
What is the focus of the study by Bergey et al. in 2015?
Long-term treatment with responsive brain stimulation in adults with refractory partial seizures ## Footnote This research investigates the long-term effects of brain stimulation therapy in adults with difficult-to-treat seizures.
581
What does the study by Salanova et al. in 2015 evaluate?
Long-term efficacy and safety of thalamic stimulation for drug-resistant partial epilepsy ## Footnote This study assesses the outcomes of thalamic stimulation for patients with drug-resistant epilepsy.
582
What is the title of the book edited by England MJ, Liverman CT, Schultz AM?
Epilepsy across the spectrum: promoting health and understanding ## Footnote This book is part of the work by the Committee on the Public Health Dimensions of the Epilepsies, Board on Health Sciences Policy, Institute of Medicine of The National Academies.
583
From which institution is the Manual of Antiepileptic Drug Therapy modified?
University of Virginia Comprehensive Epilepsy Program ## Footnote The year of publication is 2010.
584
Which edition of 'Epilepsy - the facts' is referenced?
3rd ed. ## Footnote This work is authored by Appleton RE and Marson AG, published by Oxford University Press: Clarendon.
585
In what year was the Epilepsy Products Market Share figure created?
2015 ## Footnote This information is sourced from Fore Pharma's US Epilepsy Market and Competitive Landscape Highlights - 2016.
586
What study is referenced regarding nonadherence to antiepileptic drugs?
RANSOM study ## Footnote This study's findings are published in Epilepsia 2009;50(3):501-509.
587
Who are the authors of the article on diagnosing refractory epilepsy?
Mohanraj R, Brodie MJ ## Footnote The article is published in the European Journal of Neurology 2006, 13: 277-282.
588
What is the main topic of the paper by Brodie MJ published in 2013?
Epilepsia ## Footnote This paper is referenced as 2013; 54 (Suppl. S2):5-8.
589
What is the title of the article modified from Benabis SR, Tatum WO?
When Drugs Don't Work ## Footnote The original article was published in Neurology in 2000;55:1780-1784.
590
What is the publication year and volume of the study by Kwan P et al. in Epilepsia?
2009;50(Suppl. 8):57-62 ## Footnote Additional references include Gilliam F. Neurology. 2002;58:s9-s19.
591
What is the source of the Overall Seizure Treatment Outcomes table?
Cleveland Clinic Neurological Institute ## Footnote The data was cited on June 14, 2016, and is available online.
592
Which journal published the study on long-term treatment with responsive brain stimulation?
Neurology ## Footnote This study was conducted by Bergey GK, Morrell MJ, Mizrahi EM, and published in 2015.
593
What is the final results publication of the RNS System Pivotal study's seizure reduction?
Epilepsia, 55(3):432-441, 2014 ## Footnote The study was conducted by Heck CN.
594
Fill in the blank: The figures 7 and 8 were modified from _______.
Abosch A, et al. ## Footnote This work was published in Stereotact Funct Neurosurg. 2013;91(1):1-11.
595
What is the generic name for Diazepam?
Diazepam ## Footnote Diazepam is also known by its brand names, including Valium and Diastat.
596
What is the brand name for Fosphenytoin?
Cerebyx ## Footnote Fosphenytoin is used for the treatment of status epilepticus.
597
What is the recommended dose of Diazepam for IV administration?
5-10 mg IV (0.2-0.5 mg/kg) ## Footnote This dose can also be administered per rectum.
598
What is the rate of administration for Diazepam?
2-5 mg/min ## Footnote This rate ensures a controlled onset of action.
599
What is one advantage of using Diazepam?
Fast onset of action ## Footnote This makes it effective in acute situations.
600
What is a disadvantage of using Diazepam?
Longer onset of action than IV ## Footnote This refers to its rectal administration compared to IV.
601
What is the brand name for Levetiracetam?
Keppra ## Footnote It is used for various seizure types including status epilepticus.
602
What is the recommended dose of Lorazepam for IV administration?
4-8 mg IV (0.05-0.1 mg/kg) ## Footnote This dose is effective for managing seizures.
603
What is the rate of administration for Midazolam?
2-5 mg/min ## Footnote It can be administered IV or IM.
604
What is one advantage of using Midazolam?
Can be given IM with efficacy equal to diazepam ## Footnote This provides flexibility in administration.
605
What is the recommended dose of Valproic acid for IV administration?
1500-2000 mg IV (25 mg/kg) ## Footnote This dose can be adjusted based on patient needs.
606
What is a disadvantage of using Valproic acid?
Longer onset of action than diazepam ## Footnote This may affect its use in acute situations.
607
True or False: Lorazepam has a longer onset of action than diazepam.
False ## Footnote Lorazepam generally has a quicker onset than diazepam.
608
What is the rate of administration for Fosphenytoin?
20-500 mg/min diluted 2:1 or undiluted ## Footnote This allows for flexibility in administration based on patient condition.
609
Fill in the blank: The dose for Fosphenytoin is _______ mg IV (20 mg/kg).
1400 ## Footnote This is the total maximum dose for adults.
610
What is the potential risk associated with using Lorazepam?
Possible greater chance of early seizure recurrence ## Footnote This is a consideration in ongoing management.
611
What is the advantage of using Levetiracetam?
Less sedating and few side effects ## Footnote It is often preferred for chronic administration.
612
What is the maximum dose for Midazolam in adults?
30-70 mg/kg given at 500 mg/min ## Footnote This dosing requires careful monitoring.
613
Fill in the blank: The dose for Keppra is _______ mg IV.
2500-3000 ## Footnote This is used for acute management of seizures.
614
What is the generic name of Amidate?
Etomidate ## Footnote Etomidate is used as an anesthetic in the treatment of refractory convulsive status epilepticus.
615
What is the IV loading dose of Ketamine?
1-2 mg/kg over 2-4 min ## Footnote Ketamine is used for its anesthetic properties in emergency situations.
616
What is the maintenance dose range for Midazolam?
0.3-3 mg/kg/hr ## Footnote Midazolam can be titrated to achieve seizure control.
617
What are the advantages of using Etomidate?
Does not decrease BP, fast, convenient ## Footnote Etomidate is particularly useful in patients where blood pressure management is critical.
618
What is the brand name for Propofol?
Diprivan ## Footnote Propofol is known for its rapid onset and short duration of action.
619
What is the loading dose for Pentobarbital?
1-12 mg/kg at 50 mg/min ## Footnote Pentobarbital is used to achieve burst-suppression in refractory seizures.
620
Fill in the blank: The loading dose of Midazolam is _______.
0.20 mg/kg ## Footnote Midazolam is often used for its sedative and anticonvulsant effects.
621
What is a disadvantage of using Ketamine?
Increased BP, may cause dissociative side effects ## Footnote These side effects can complicate its use in certain patients.
622
What is the maintenance dose for Propofol?
1-15 mg/kg/hr (15-240 mcg/kg/min) ## Footnote Propofol requires careful titration to achieve the desired effect.
623
True or False: Phenobarbital is known for causing adrenal suppression.
True ## Footnote This side effect can limit its use in certain populations.
624
What is a significant disadvantage of using Phenobarbital?
Not available, melts plastics, renal and liver toxicity ## Footnote These factors can complicate its administration and safety profile.
625
What is the IV loading dose for Paraldehyde?
0.3 mg/kg per rectum ## Footnote Paraldehyde can be administered rectally for rapid effect.
626
What is the maintenance dose for Pentobarbital?
1-5 mg/kg/hr titrated to burst-suppression ## Footnote This medication is often used for refractory cases where other treatments have failed.
627
Fill in the blank: The generic name for Nembutal is _______.
Pentobarbital ## Footnote Pentobarbital is a barbiturate used in the management of seizures.
628
What is a major concern when using Propofol?
Hypotension usually requires fluid and pressors ## Footnote Monitoring is crucial when using Propofol due to its effects on blood pressure.
629
What is the advantage of using Midazolam in emergency settings?
Effective, given per rectum ## Footnote Its rectal formulation allows for quick administration in non-intubated patients.
630
What is the loading dose for Propofol?
10-20 mg/kg at 50-100 mg/min ## Footnote This rapid administration is crucial for achieving desired sedation levels.

Epilepsy Modules (3 decks)

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