Neurology - Epilepsy(51) Flashcards
NEU - 4.1
Efficacy of pharmacotherapy in the epilepsy population:
A) 30%
B) 40%
C) 70%
D) 99%
E) 15%
ANSWER
C) 70%
EXPLANATION
60-70% of patients with epilepsy become seizure free by using epileptic drugs.
NEU - 4.2
NOT a characteristic of psychogenic non-epileptic seizures:
A) closed eyes
B) variable seizure duration
C) lateral tongue biting
D) variable seizure symptoms
E) paroxysmal motor phenomena
ANSWER
C) lateral tongue biting
EXPLANATION
Grand mal (generalized tonic-clonic seizure) should be differentiated from convulsive syncope and the psychogenic non-epileptic seizure (pseudoseizure, „hysteric” seizure). The latter is characterized by variable seizure duration, variable seizure symptoms (semiology), and closed eyes. The lateral tongue biting is a highly specific sign of epileptic seizure.
NEU - 4.3
Oral and manual automatisms are characteristics for:
A) absence
B) complex partial seizures
C) generalized tonic-clonic seizures
D) sensomotor Jacksonian seizure
E) tetany
ANSWER
B) complex partial seizures
EXPLANATION
Oral automatisms (lip smacking, chewing, or swallowing) and manual automatisms (pillrolling, finger rubbing) are the main characteristics of complex partial seizures which usually originate from the temporal lobe.
NEU - 4.4
Epileptic aura is:
A) an antiepileptic side effect
B) a risk factor for status epilepticus
C) always accompanied by loss of consciousness
D) the first sign of a focal seizure
E) the first sign of an absence seizure
ANSWER
D) the first sign of a focal seizure
EXPLANATION
Epileptic aura is an epileptic seizure without objective signs (the patient has only subjective experiences during the seizure). Auras last a few seconds. Auras can also be followed by proper seizures (such as seizures with objective signs), but this is not obligatory: auras can stand alone.
NEU - 4.5
Antiepileptic drug with a specific indication:
A) TSH
B) L-dopa
C) acetylcholine
D) ACTH
E) digitalis
ANSWER
D) ACTH
EXPLANATION
One of the most severe epileptic encephalopathies in infants is the West syndrome consisting of typical seizure form (BNS seizure or infantile spasm) and typical EEG sign (hypsarrhythmia). „Classical” antiepileptic drugs with exception of vigabatrin are less effective in this syndrome. Conversely, ACTH and steroid treatment can be very effective, may result in compete seizure freedom.
NEU - 4.6
NOT effective in focal epilepsy:
A) carbamazepine
B) diphenylhydantoin
C) vigabatrin
D) ethosuximide
E) oxcarbazepine
ANSWER
D) ethosuximide
EXPLANATION
Some antiepileptics are more effective in focal, while others in generalized seizures. Carbamazepine is mainly useful in treating focal (or focal-onset) seizures. Ethosuximid has an effect on absence seizures only.
NEU - 4.7
First-choice drug in idiopathic generalized epilepsy:
A) valproate
B) dyphenylhydantoin
C) diazepam
D) Vitamin B6
E) carbamazepine
ANSWER
A) valproate
EXPLANATION
The first-choice drug in idiopathic generalized epilepsy is the valproate. In fertile women, however, it should be avoided due to its teratogenic effect.
NEU - 4.8
NOT a characteristic of convulsive syncope:
A) open eyes
B) jerking
C) sweating
D) pallor
E) lateral tongue biting
ANSWER
E) lateral tongue biting
EXPLANATION
Grand mal (generalized tonic-clonic seizure) should be differentiated from convulsive syncope and the psychogenic non-epileptic seizure (pseudoseizure, „hysteric” seizure). Convusiv syncope – like any syncope – can precede by fainting sensation, pallor, or sweating. Conversely, during the unconsciousness, a brief tonic phase, myoclonic or clonic jerking can occur. In contrast to grand mal, convulsive syncope never begins with a tonic phase (it starts with a loss of muscle tone). Tongue biting can also occur in convulsive syncope, but it never affects the lateral part of tongue, rather the tip of tongue (apical tongue biting).
NEU - 4.9
In pregnant women taking antiepileptic drugs:
A) an abortion is recommended
B) 1000 mg/day Vitamin C is recommended
C) 1–5 mg/day folic acid is recommended
D) Vitamin K should be given during the whole pregnancy period
E) bed rest is recommended during the 3rd trimester
ANSWER
C) 1–5 mg/day folic acid is recommended
EXPLANATION
Pregnant women with epilepsy should receive folic acid supplementation due to potential teratogenic effects of chronic antiepileptic drug treatment. This has to start when planning a pregnancy.
NEU - 4.10
Major fetal (congenital) malformations caused by antiepileptic drugs can be detected by:
A) measuring CPK level
B) Ultrasound examination
C) antinuclear antibody test
D) measuring estrogen level
E) measuring progesterone level
ANSWER
B) Ultrasound examination
EXPLANATION
Major fetal (congenital) malformations can be detected by ultrasound examinations.
NEU - 4.11
If a grand mal seizure appears during pregnancy:
A) cesarean section is indicated
B) antiepileptic drug dosage should be reduced
C) new antiepileptic drugs should be introduced in small dosage
D) measuring serum level of antiepileptic drugs is recommended the dosage should be modified accordingly
E) bed rest is recommended
ANSWER
D) measuring serum level of antiepileptic drugs is recommended the dosage should be modified accordingly
EXPLANATION
Metabolism of antiepileptic drugs can be influenced by pregnancy, resulting in a less effective anti-seizure effect. This can be verified by measuring serum level of antiepileptic drugs. The dosage of antiepileptics should be modified accordingly.
NEU - 4.12
The most frequently used type of epilepsy surgery is:
A) parietal lobectomy
B) temporal lobectomy
C) callosotomy
D) hemispherectomy
E) multiple subpial transection
ANSWER
B) temporal lobectomy
EXPLANATION
Most adult patients with pharmacoresistant epilepsy have temporal lobe epilepsy. The most common epilepsy surgery procedure is the temporal lobectomy.
NEU - 4.13
Epileptic seizures are NOT characteristics of:
A) epilepsy
B) alcohol withdrawal
C) benzodiazepine withdrawal
D) sinus thrombosis
E) myasthenia gravis
ANSWER
E) myasthenia gravis
EXPLANATION
Epilepsy is defined by recurrent unprovoked epileptic seizures. Typical seizure provoking factors are: alcohol withdrawal and repetitive photic stimulation. Severe acute neurological disorders affecting cerebral cortex (for example sinus thrombosis) can also be accompanied by epileptic seizures. Myasthenia gravis is an autoimmune disorder of the neuromuscular junction. It does not affect the central nervous system thus it is not accompanied by epileptic seizures.
NEU - 4.14
NOT an antiepileptic drug:
A) moclobemide
B) clobazam
C) lamotrigine
D) gabapentin
E) levetiracetam
ANSWER
A) moclobemide
EXPLANATION
The moclobemide is a reversible MAO-A inhibitor (RIMA), an antidepressant.
NEU - 4.15
NOT an antiepileptic drug:
A) carbamazepine
B) vigabatrin
C) valproate
D) levetiracetam
E) alprazolam
ANSWER
E) alprazolam
EXPLANATION
Alprazolam is a benzodiazepin, its antiepileptic effect is infinitesimal.
NEU - 4.16
Interictal EEG sign suggesting epilepsy:
A) vertex potential in sleep
B) 3 Hz spike-and-wave complex
C) 6–14 Hz positive discharges
D) none of them
E) all of them
ANSWER
B) 3 Hz spike-and-wave complex
EXPLANATION
The vertex potential on the EEG is characteristic to the light sleep. This is a physiological phenomenon. The 6-14 Hz positive spikes are normal (physiological) variations of the EEG. A 3Hz spike-and wave complex is the typical EEG sign of some genetically determined epilepsy forms, such as idiopathic generalized epilepsy including absence epilepsy.
NEU - 4.17
Side effect of valproate:
A) hair loss
B) weight gain
C) tremor
D) all of them
E) none of them
ANSWER
D) all of them
EXPLANATION
Hair loss, tremor, and weight gain are the most frequent side effects of valproate treatment.
NEU - 4.18
An epileptic patient taking antiepileptic drugs:
A) is permitted to drive a car if he/she is long-term seizure free
B) is permitted to drive a car but only after withdrawal of antiepileptic drugs
C) is not permitted to drive a car
D) is permitted to drive a car but only under supervision
ANSWER
A) is permitted to drive a car if he/she is long-term seizure free
EXPLANATION
Long-term seizure-free patients are permitted to have a driving license (and driving a car), regardless whether the seizure freedom has been achieved with or without antiepileptic drug treatment. The „long-term” seizure free interval is not universally defined, this interval depends on the actual country laws.
NEU - 4.19
Which seizure type can NOT appear after a traumatic brain injury?
A) generalized tonic-clonic seizure
B) absence
C) complex partial seizure
D) focal motor seizure
E) Jacksonian seizure
ANSWER
B) absence
EXPLANATION
Traumatic brain injury can cause focal („posttraumatic”) epilepsy. Absence seizures occur in genetically determined epilepsy syndromes.
NEU - 4.20
Which is NOT true for epilepsy?
A) diagnosis of epilepsy does not exclusively based on the EEG
B) focal EEG abnormality is an indication for a CT or MRI examination
C) after cessation of seizures, the antiepileptic drugs can be stopped immediately
D) the underlying etiology should also be treated in cases of symptomatic epilepsy
E) most antiepileptic drugs require a slow titration
ANSWER
C) after cessation of seizures, the antiepileptic drugs can be stopped immediately
EXPLANATION
Epilepsy can be considered to be cured, if the patient had become seizure-free for at least 3 years and remained seizure free for another 2 years. In some adulthood epilepsy syndromes (for example in juvenile myoclonic epilepsy), despite a complete seizure freedom, antiepileptics cannot be stopped (there is a high risk of recurrence after antiepileptic withdrawal): these epilepsy forms require a lifelong antiepileptic treatment.