Seizures

Question 1

Hyperventilation brings out which type of seizure?

Answer 1

Absence seizures

Question 2

The EEG of absence seizures shows what?

Answer 2

Spike and wave activity at 3 Hz

Question 3

In what way are absence seizures different from complex partial seizures?

Answer 3

There is no post-ictal state with absence seizures.

Question 4

What does EEG look like in juvenile myoclonic epilepsy?

Answer 4

Normal background with frequent generalized polyspike and wave discharges diffusely throught at 4-6Hz.

Question 5

A 15yo teased by his family for being clumsy, myoclonic jerks upon wakening, might have…

Answer 5

Juvenile myoclonic epilepsy

Question 6

Treatment for juvenile myoclonic epilepsy:

Answer 6

Depakote, or Keppra

Question 7

Seizure triggered by sleep deprivation (teenager staying out all night):

Answer 7

Juvenile myoclonic epilepsy

Question 8

Jacksonian March

Answer 8

Pattern of a seizure progressing up someone’s body (arm) before generalizing.

Question 9

Simple partial seizure

Answer 9

Begins in a definitive area in the brain and does not affect consciousness. Motor, sensory, autonomic, psychiatric symptoms, often a sense of oerwhelming fear or depersonalization.

Question 10

Complex partial seizure

Answer 10

Begins in a definitive area in the brain and does affect consciousness.

Question 11

An aura is always a sign of a _____.

Answer 11

focal seizure

Question 12

Primary generalized seizure

Answer 12

Affects the whole brain at the same time. Consciousness is lost. These include absence, atonic, tonic, and tonic-clonic seizures.

Question 13

Secondarily generalized seizure

Answer 13

Affects a single area of teh brain initially, and then spreads to include the rest of the brain.

Question 14

Todd’s paralysis

Answer 14

A focal neurological deficit, usually weakness, that persists for up to 24 hours after a seizure.

Question 15

What is Landau-Kleffner syndrome?

Answer 15

Progressive aphasia in children, affecting both Broca’s and Wenicke’s areas. Onset usually between 3-7 years, epileptiform activity during non-REM sleep.

Question 16

Characteristics of tuberous sclerosis:

Answer 16

cortical tubers, ash-leaf macules (hypopigmented lesion), GERD

Question 17

What are infantile spasms and how are they treated?

Answer 17

Seizures associated with tuberous sclerosis, excess CRH that causes excess exitability. Treated with ACTH.

Question 18

What is West Syndrome?

Answer 18

Occurs in infants, consists of triad of infantile spasms, pathognomonic EEG pattern called hypsarrhythmia, and mental retardation.

Question 19

What is Lennox-Gastaut Syndrome?

Answer 19

Ages 2-6, difficult to control seizures, include tonic and atonic, atypical absence, and myoclonic seizures.

Question 20

What is the most common epilepsy syndrome in children?

Answer 20

Benign rolandic epilepsy/Epilepsy with centrotemporal spikes. Nocturnal seizures and rarely needs treatment, remits by age 16.

Question 21

What are gelastic seizures?

Answer 21

Neoplasm of the hypothalamus, characterized by laughing fits.

Question 22

What are pseudoseizures?

Answer 22

Non-epileptic, characterized by different movements, lasting different amounts of time.

Question 23

Which electrolyte abnormality is NOT associated with seizures?

Answer 23

Hypermagnesemia

Question 24

NTDs in pregnancy are strongly associated with which anti-epileptic med?

Answer 24

Depakote

Question 25

Which anti-epileptic is contraindicated with Hx of kidney stones?

Answer 25

Topiramate

Question 26

Anti-seizure meds associated with hyponatremia:

Answer 26

Oxcarbazepine, carbamazepine

Question 27

Which seizure med will mess up your teeth?

Answer 27

Phenytoin

Question 28

Status epilepticus

Answer 28

Life-threatening usually defined as a seizure lasting longer than 5-10 min, or recurrent seizures without regaining consciousness between seizures for greater than 30 min.

Question 29

What is a corpus callosotomy and when is it used?

Answer 29

A lesion made in the corpus callosum, used in patients with refractory epilepsy to prevent partial seizures from spreading across the brain to become generalized.

Question 30

Electronic stimulation of which cranial nerve is used to help control epilepsy?

Answer 30

Vagus

Question 31

What is given to women with eclampsia to prevent seizures?

Answer 31

Magnesium sulfate

Question 32

When are prophylactic anticonvulsants used?

Answer 32

Severe head trauma

Question 33

Indications and side effects of carbamazipine (Tegretol):

Answer 33

Partial seizures; an worsen absence, myotonic, and atonic seizures. Hyponatremia, vertigo, headache, ataxia, blood dyscrasias.

Question 34

Indications and side effects of Oxcarbazepine (trileptal):

Answer 34

Partial seizures; can lead to hyponatremia, but does not affect the levels of other medications.

Question 35

Indications for lacosamide (Vimpat):

Answer 35

Poorly controlled partial-onset seizures

Question 36

Indications and side effects for Phenytoin (Dilantin):

Answer 36

Partial seizures, GTC, tonic and atonic seizures; gum hyperplasia, osteoporosis, hirsuitism, rash, ataxia, nystagmus, confusion at high levels.

Question 37

Indications and side effects of Lamotrigine (Lamictal):

Answer 37

Juvenile myoclonic epilepsy and Lennox-Gastaut syndrome; Steven-Johnson syndrome, especially if started at high doese.

Question 38

Side effects of leviteracetam (Keppra):

Answer 38

Depression, psychosis

Question 39

Indications and side effects for Tiagabine (Gabitril):

Answer 39

Adjunctive treatment for partial seizures; sedation and cognitive slowing.

Question 40

Indications and side effects for Topiramate (Topamax):

Answer 40

Monotherapy in partial or mixed seizures, drop attacks in Lennox-Gastaut syndrome; nephrolithiasis, weight loss, cognitive slowing at higher doses.

Question 41

Indications and side effects for Zonisamide (Zonegran):

Answer 41

Adjunctive treatment in partial seizures; nephrolithiasis, weight loss.

Question 42

Indications and side effects for Vigabatrin (Sabril):

Answer 42

Infantile spasms due to tuberous sclerosis; visual loss.

Question 43

Indications and side effects of Valproate (Depakote):

Answer 43

Primary generalized epilepsies including absence, myoclonic, and tonic-clonic seizures; weight gain, pancreatitis, hepatic toxicity, interacts with many other AEDs.

Question 44

Indications for ethosuximide (Zarontin):

Answer 44

Used only in absence seizures.