Neurology 4.10

Question 1

epilepsy

Answer 1

predisposition to recurrent seizures

Question 2

seizure

Answer 2

synchronized, high-frequency neuronal firing

Question 3

seizure or epilepsy: symptomatic or provoked

Answer 3

seizure

Question 4

seizure or epilepsy: unprovoked and isolated

Answer 4

may be epilepsy; too early to tell

Question 5

seizure or epilepsy: recurrent and unprovoked

Answer 5

epilepsy

Question 6

What are seizure mimic conditions?

Answer 6

• syncope (sudden loss of consciousness) or cardiac arrest due to hypoxemia +/- hypotension
• acute drug toxicity
• migraine
• metabolic/endocrine [encephalopathy]

Question 7

What is the most common serious neurologic disorder?

Answer 7

epilepsy

Question 8

What is the bimodal curve of epilepsy?

Answer 8

highest incidence in pediatrics and geriatrics

Question 9

Which percentage of cases of epilepsy are idiopathic?

Answer 9

50-60%

Question 10

What is the main consequence of epilepsy to society?

Answer 10

cost [diagnosis and initial treatment particularly high]

Question 11

What is the most important thing to consider when diagnosing epilepsy?

Answer 11

• history and observation

testing: EEG, MRI, blood work, lumbar puncture

Question 12

What is the important genetic component of epilepsy?

Answer 12

primary generalized epilepsy: Juvenile Myoclonic Epilepsy

Question 13

What are risk factors for recurrence of an initial seizure?

Answer 13

• first seizure before 16 y/o
• seizure during sleep/early morning
• mental retardation
• neurologic deficit
• sibling with epilepsy

Question 14

Why might simple partial or complex seizures be read as normal on an EEG?

Answer 14

lesion is deep within the brain

Question 15

What is a localization related seizure?

Answer 15

partial/focal seizure (60% of all)

Question 16

How do prodrome and aura differ?

Answer 16

prodrome:
-forewarning hours before seizure

aura:

• actual manifestation of partial seizure
• aids in localization

Question 17

What is Mesial Sclerosis?

Answer 17

• complex partial seizure

- commonly bilateral in temporal lobes; early adulthood onset/occurance

Question 18

What is the duration of a complex partial seizure?

Answer 18

1-3 minutes

w/ secondary generalization 2-4 minutes

Question 19

What is the main manifestation of complex partial seizures?

Answer 19

automatisms

• picking at clothes
• smacking lips
• wandering
• repeating words

Question 20

What is Todd’s postictal hemi-paralysis suggestive of?

Answer 20

origin location; complex partial seizure with secondary generalization

Question 21

Why are absence seizures typically not noticed?

Answer 21

• quick
• no warning/aura
• consciousness lost briefly but immediately regained

Question 22

What is the recurrence rate of febrile seizures?

Answer 22

high

Question 23

What is the best timing of performing an EEG?

Answer 23

best within 24 hours of seizure and sleep-deprived

Question 24

What are the recurrence rates after an initial seizure in children and adults?

Answer 24

children: 29% [25-33% relapse after medication stopped]
adults: 33% [50% relapse after medication stopped]

Question 25

Are anti-epileptic drugs neuroprotective?

Answer 25

no; discontinue after 2-5 years (usually)

Question 26

Why is the relapse rate lower in children than in adults?

Answer 26

absence seizure more typical in children

Question 27

How is therapy in epilepsy initiated?

Answer 27

monotherapy is preferable; only sufficient in 50% of patients
[2= +13%, 3= +4%]