Mngt Epilepsy - Cases Flashcards
A patient at a Hospital has a sudden onset of tonic-cloinic seizure attack. After appropriate Seizure First-aid, Jane, who was the Pcist started timing the Seizure.
Which of the following is the appropriate action to take for this patient, given that the time since his seizure started was 7 minutes?
A. Feed the patient water B. Initiate IV Midazolam C. Initiate IV Valproic Acid D. Initiate IV Thiopental E. Initiate Rectal Diazepam
Ans: E (Rectal Diazepam)
- A: inappropriate seizure first-aid
- B: IV Midazolam not rapid-acting enough (use IM instead)
- C: only for second therapy phase (20-40min)
- D: Only for third Therapy Phase (40-60min)
Yuya is a 66yo M patient who presents with new onset of Focal onset Seizures. He had at least 2 unprovoked seizures which he describes as having flashbacks and tingling sensations at his extremities in the last 2 months, and are not consecutive. The Doctor dx him with Epilepsy and wants to initiate treatment for Yuya.
Yuya has PMH: HTN, HLD, DM, and has NKDA
Which of the following AED is the MOST appropriate for Yuya?
A. Ketogenic Diet B. Lamotrigine C. Clobazam D. Phenytoin E. Levotiracetam
Ans: B (ILAE guidelines)
- A: For patient who no respond to AED, usualyl for young children to prevent seizures
- C: For Refractory focal onset
- D: Not the best option (no evi in elderly)
- E: Not the best option (no evi in elderly)
(recall another option for Elderly?? –> Gabapentin)
Tutu is a 45yo F who was dx with General Onset Epilepsy and was prescribed an AED during her visit to the doctor 2 weeks ago. She complains that she experienced nausea and vomiting which started a week ago and has not stopped since then. She would prefer to have another AED if possible.
What was the most likely drug that she was prescribed ?
A. Valproate B. Levotiracetam C. Topiramate D. Pregabalin E. Gabapentin
Ans: A (SE: NNV + used in general onset)
- B: Not used in General Onset (SE is behaviour disturbance)
- C: SE is usually Cognition (speech)
- D: Not used in General Onset
- E: Not used in General Onset
Tutu is a 45yo F who was dx with General Onset Epilepsy and was prescribed VPA during her visit to the doctor 2 weeks ago. She complains that she experienced nausea and vomiting which started a week ago and has not stopped since then. She have not experienced any seizures so far. She would prefer to have another AED if possible.
Her PMH: NIL
NKDA
Suggest which of the following action is the most appropriate for Tutu
A. Lower the dose of VPA B. Switch VPA to CBZ C. Switch VPA to LTG D. Switch VPA to PHT E. Add TPM in combination with VPA
Ans: C (LTG for general onset)
- A: She just visited doctor, initial dose is lowest
- B: CBZ not for general onset
- D: PHT not for general onset
- E: Too early for combi + patient has not show suboptimal response
(recall: Tx principle: First AED got AE not tolerated = SUB it)
(recall tx principle: Combi only if tolerate first OR second but with SUBOPTIMAL response)
WT is a 67yo M who recently experienced a seizure attack. Before the seizure attack, he mentioned that he was sweating profusely and was feeling very dizzy. He also felt that his extremities were numb. Prior to that, he has no brain damage nor any CNS disorders that was diagnosed. Prior to that episode. he has no other episodes of Seizure
PMH: DM, HLD
Meds: Insulin Aspart, Insulin Glargine, Simva20
Which of the following is the most appropriate action for WT?
A. Initiate GBP B: Initiate LEV C. Start Ketogenic Diet D. Review WT's current medications E. Review WT's biochemical balance
Ans: D
- Epilepsy Dx criteria: TWO UNPROVOKED seizures, or Dx Epilepsy Syndrome
- In this case, WT probably has seizure due to provocation, possibly Hypoglycemia
- Hence there is no indication to tx epilepsy or assess him for epilepsy
- Thus D is most appropriate (review meds, curb hypoglycemia)
A patient suddenly collapses onto the floor. Moments later, he was able to stand back up on his own.
Which of the following type of seizure best fits the above description?
A. Tonic-Clonic B. Tonic C. Clonic D. Atonic E. Myoclonic
Ans: D (Loss muscle tone then drop like rag-doll)
- A: Tonic phase and Clonic Phase
- B: Tonic -> LOSS conscious + Whole body Rigid
- C: Clonic -> Assymetrical and Irregular Jerking
- E: Myoclonic -> Brief Contraction usually bilateral, can be one leg or one arm
A patient describes that she has a “bad feeling” each time before an episode of seizure attack, which will last less than 5 minutes.
Which of the following types of seizure best fits the above description? You can choose more than one answer
A. Simple Partial B. Complex Partial C. Grand Mal D. Absence E. Status Epilepticus
Ans: A,B,C
D: No Aura
E: more than 5 minutes Seizure
ET is a 34-yo lady who is diagnosed with Epilepsy (General onset). She currently has two children, and wants one more child before the age of 35. She is otherwise healthy. NKDA. Tests have revealed that she is HLB*1502 positive.
Which of the following AED is most appropriate for ET?
A. TPM B. LTG C. VPA D. LEV E. CBZ
Ans: B
- TPM and VPA: For General onset but NOT suitable for preggo
- LEV: Can for preggo, but NOT general onset
- CBZ: Not general onset + HLB*1502 positive cannot use
MT is a 49yo M who is diagnosed with Epilepsy (Focal onset). His past medical history is significant for moderate liver impairment, dyspepsia and depression (MDD). His renal function is normal. He has NKDA. Tests have revealed that he is HLB*1502 Positive.
Which of the following AED is most appropriate for MT? A. CBZ B. PHT C. VPA D. LEV E. GBP
Ans: E (GBP)
- A: HLB positive cannot CBZ
- B: PHT is H cleared, best to avoid in liver impairment
- C: VPA is H cleared, best to avoid in liver impairment
- D: LEV can but caution in depression, best to avoid
Hence only E is an option
(what about LTG? CANNOT –> The 2nd gen AED which is H cleared as well!!!)
Georgio is a 50yo man who was diagnosed with epilepsy and administered low dose TPM a week ago. He then comes back saying “This drug does nothing for me! I got another seizure attack all thanks to this drug”
Which of the following is/are appropriate? You can choose more than one answer
A. Seizure is due to non-compliance of TPM
B. Seizure is due to withdrawal effect of TPM
C. TPM should be changed to LTG
D. GBP should be added to his therapy
E. Dose of TPM can be titrated up
Ans: A,E
- C: No need switch, since no SE of TPM yet (speech fluency decreased)
- D: No need combi therapy yet
