Seizures

Question 1

What is the definition of status epilepticus?

Answer 1

Clinical or electrographic seizure activity for at least 5 minutes, or at least 2 seizures without recovery in between.

Question 2

What is the definition of refractory status epilepticus?

Answer 2

Failure of benzodiazepine and 1 anti-epileptic drug.

Question 3

What are the potential AEDs you would use for initial maintenance after status epilepticus (4)?

Answer 3

(1) Phenytoin 20 mg/kg
(2) Valproic Acid 40 mg/kg
(3) Levetiracetam 60 mg/kh
(4) Fosphenytoin 20 mg PE/kg

Question 4

When an individual is in refractory status epilepticus, which medications might you use as an infusion to suppress seizure activity (3)?

Answer 4

(1) Midazolam
(2) Propofol
(3) Pentobarbital

Question 5

What is the definition of epilepsy?

Answer 5

At least 2 unprovoked seizures more than 24 hours apart.

OR

1 unprovoked seizure with a risk > 60% or recurrence.

OR

Epilepsy Syndrome

Question 6

What makes your risk fo seizure recurrence > 60% after the 1st seizure?

Answer 6

An abnormal EEG or MRI.

Question 7

What is the yield of routine EEG in identifying evidence of epilepsy?

Answer 7

Routine EEG yield is low (30%) but improves (50%) if performed within 24 hours of the event.

Serial EEGs also improves the yield to 70% and sleep deprivation improves the yield to 50%.

Question 8

Which antiepileptic medications are indicated in the treatment of absence seizures (2)?

Answer 8

(1) Ethosuximide

(2) Valproate

Question 9

Which antiepileptic drugs should be avoided in idiopathic generalized epilepsy (5)?

Answer 9

(1) Carbamazepine
(2) Phenytoin
(3) Oxcarbazepine
(4) Eslicarbazepine
(5) Gabapentin

Question 10

Which anti-epileptic drugs should be used first line in myoclonic generalized seizures(2)?

Answer 10

(1) Levetiracetam

(2) Valproate

Question 11

Which antiepileptic drugs are considered safe during pregnancy?

Answer 11

(1) Levetiracetam

(2) Lamotrigine

Question 12

Which anti-epileptic drugs are considered first line for focal seizures?

Answer 12

Carbamazepine
Oxcarbazepine
Phenytoin
Lacosamide

Question 13

What the the side effects of anti-epileptic drugs?

Answer 13

S - Sedation
C - Cognitive Impairment
A - Ataxia/Dizziness
R - Rash
E - Emesis/GI Upset
D - Diplopia/Visual Disturbance

Question 14

In which anti-epileptic is weight gain a concern?

Answer 14

Valproate

Question 15

Which anti-epileptic is known to cause weight loss?

Answer 15

Topiramate

Question 16

Which antiepileptic medications are known to cause Stevens-Johnson syndrome (4)?

Answer 16

(1) Phenytoin
(2) Lamotrigine
(3) Carbamazepine
(4) Oxcarbazepine

Question 17

What is purple glove syndrome?

Answer 17

A poorly understood skin disease in which the extremities become swollen, discoloured and painful. Commonly among those receiving multiple doses of IV phenytoin.