Seizure Disorder

Question 1

What is the definition of epilepsy?

Answer 1

Epilepsy is a disorder of the brain characterized by an enduring predisposition to generate epileptic seizures and by associated neurobiological, cognitive, psychological, and social consequences.

Question 2

What are the two main peaks of epilepsy onset?

Answer 2

Epilepsy commonly has two peaks of onset: in childhood and older adulthood.

Question 3

What are the operational criteria for diagnosing epilepsy?

Answer 3

1. At least two unprovoked seizures >24 hours apart. 2. One unprovoked seizure with a high probability of recurrence (≥60%) over 10 years. 3. Diagnosis of an epilepsy syndrome.

Question 4

What is the global incidence of epilepsy?

Answer 4

Estimated at 5 million new cases per year.

Question 5

What is the underlying pathophysiology of seizures?

Answer 5

Seizures occur due to abnormal, excessive, and hypersynchronous neuronal discharges in the brain.

Question 6

What is epileptogenesis?

Answer 6

The process by which normal neuronal networks become hyperexcitable and prone to recurrent seizures.

Question 7

What are common causes of symptomatic seizures?

Answer 7

Hypoglycemia, electrolyte imbalance, CNS infections, head injuries, stroke, and drug toxicity.

Question 8

What is the primary mechanism leading to hyperexcitability in epilepsy?

Answer 8

Imbalance between excitatory (glutamate) and inhibitory (GABA) neurotransmission.

Question 9

What structural changes contribute to epilepsy development?

Answer 9

Gliosis, neurogenesis, sodium and potassium channelopathies, blood-brain barrier dysfunction, and aberrant synaptic plasticity.

Question 10

What are the three diagnostic levels in epilepsy classification?

Answer 10

1. Seizure type, 2. Epilepsy type, 3. Epilepsy syndrome.

Question 11

What are the three major types of seizures?

Answer 11

1. Focal seizures, 2. Generalized seizures, 3. Unknown onset seizures.

Question 12

What are the main classifications of generalized seizures?

Answer 12

Tonic-clonic, myoclonic, absence, atonic, tonic, and clonic seizures.

Question 13

What are the main classifications of focal seizures?

Answer 13

Focal aware seizures and focal impaired awareness seizures.

Question 14

What are examples of genetic epilepsy syndromes?

Answer 14

Dravet syndrome, childhood absence epilepsy, and juvenile myoclonic epilepsy (JME).

Question 15

What are examples of structural causes of epilepsy?

Answer 15

Hippocampal sclerosis, cortical malformations, tumors, and vascular malformations.

Question 16

What infections can cause epilepsy?

Answer 16

Neurocysticercosis, cerebral malaria, tuberculosis, toxoplasmosis, and HIV-associated encephalitis.

Question 17

What metabolic disorders can cause epilepsy?

Answer 17

Porphyria, uremia, pyridoxine-dependent seizures, and cerebral folate deficiency.

Question 18

What autoimmune disorders can cause epilepsy?

Answer 18

Anti-NMDA receptor encephalitis and lupus-associated epilepsy.

Question 19

What is the gold standard investigation for epilepsy?

Answer 19

Electroencephalography (EEG).

Question 20

What EEG findings are characteristic of focal epilepsy?

Answer 20

Focal epileptiform discharges, sharp waves, and focal slowing.

Question 21

What EEG findings are characteristic of generalized epilepsy?

Answer 21

Generalized spike-and-wave or polyspike discharges.

Question 22

What imaging modality is preferred for epilepsy evaluation?

Answer 22

Brain MRI.

Question 23

What are the first-line antiepileptic drugs (AEDs) for focal seizures?

Answer 23

Carbamazepine, lamotrigine, levetiracetam, and oxcarbazepine.

Question 24

What are the first-line AEDs for generalized tonic-clonic seizures?

Answer 24

Valproate, lamotrigine, levetiracetam, and topiramate.

Question 25

What are the first-line AEDs for absence seizures?

Answer 25

Ethosuximide, valproate, and lamotrigine.

Question 26

Which AEDs are preferred in women of childbearing age?

Answer 26

Lamotrigine and levetiracetam due to lower teratogenic risk.

Question 27

Which AED should be avoided in pregnancy due to high teratogenicity?

Answer 27

Valproate.

Question 28

What is the definition of status epilepticus?

Answer 28

Seizures lasting ≥5 minutes or recurrent seizures without regaining consciousness between episodes.

Question 29

What is the first-line treatment for generalized convulsive status epilepticus (GCSE)?

Answer 29

IV lorazepam or diazepam.

Question 30

What is the next step if benzodiazepines fail in GCSE?

Answer 30

IV phenytoin, fosphenytoin, valproate, or levetiracetam.

Question 31

What is refractory status epilepticus?

Answer 31

Seizures persisting despite two appropriately dosed AEDs.

Question 32

What are common causes of status epilepticus?

Answer 32

Stroke, infections, metabolic disturbances, withdrawal syndromes, and AED nonadherence.

Question 33

What surgical options exist for drug-resistant epilepsy?

Answer 33

Temporal lobectomy, corpus callosotomy, and vagus nerve stimulation (VNS).

Question 34

What dietary therapy can be used for refractory epilepsy?

Answer 34

Ketogenic diet.

Question 35

What are key risk factors for epilepsy-related mortality?

Answer 35

Sudden unexpected death in epilepsy (SUDEP), status epilepticus, and seizure-related injuries.

Question 36

What is SUDEP?

Answer 36

Sudden unexplained death in a person with epilepsy, often during sleep.

Question 37

What precautions should be taken for patients with epilepsy?

Answer 37

Avoid swimming alone, driving restrictions, and proper medication adherence.

Question 38

What is mesial temporal lobe epilepsy (MTLE)?

Answer 38

A common epilepsy syndrome often associated with hippocampal sclerosis.

Question 39

What are common triggers for seizures?

Answer 39

Sleep deprivation, stress, alcohol withdrawal, and flashing lights (in photosensitive epilepsy).

Question 40

What is a psychogenic non-epileptic seizure (PNES)?

Answer 40

A seizure-like event without abnormal EEG activity, often due to psychological factors.

Question 41

How can PNES be distinguished from true epilepsy?

Answer 41

EEG during an event shows no epileptiform activity, and seizures often have variable presentation.

Question 42

What is the role of vagus nerve stimulation (VNS) in epilepsy?

Answer 42

Adjunctive therapy for drug-resistant epilepsy to reduce seizure frequency.

Question 43

What is the recommended treatment duration before considering stopping AEDs?

Answer 43

Seizure-free for at least 2 years with no high-risk factors.

Question 44

What is febrile status epilepticus?

Answer 44

A prolonged seizure (>5 min) associated with fever in children without an underlying CNS infection.

Question 45

What metabolic disturbances can trigger seizures?

Answer 45

Hypoglycemia, hyponatremia, hyperglycemia, hypocalcemia, and uremia.

Question 46

What is the most common cause of epilepsy in low-income countries?

Answer 46

Neurocysticercosis.

Question 47

Which neurodegenerative diseases are associated with epilepsy?

Answer 47

Alzheimer’s disease, Parkinson’s disease, and multiple sclerosis.

Question 48

Which AED is preferred for juvenile myoclonic epilepsy?

Answer 48

Valproate.

Question 49

What is the role of EEG in epilepsy diagnosis?

Answer 49

Helps confirm epilepsy, classify seizure type, and guide treatment decisions.

Question 50

Which AEDs can worsen absence seizures?

Answer 50

Carbamazepine and phenytoin.

Question 51

What are common side effects of phenytoin?

Answer 51

Gingival hyperplasia, ataxia, hirsutism, and osteomalacia.

Question 52

What is the best treatment for focal epilepsy with hippocampal sclerosis?

Answer 52

Surgical resection (temporal lobectomy).