Seizures and Epilepsy

Question 1

Paroxysmal, time-limited changes in motor activity and/or behavior that result from abnormal electrical activity in the brain

Transient occurrence of signs/symptoms resulting from ABNORMAL EXCESSIVE or SYNCHRONOUS neuronal activity in the brain

Answer 1

Seizures/convulsions

Question 2

General term to include any one of the ff: epilepsy, febrile seizures secondary to metabolic, infectious or other etiologies

Answer 2

Seizure Disorder

Question 3

Disorder of the brain characterized by an enduring PREDISPOSITION TO GENERATE SEIZURES and by the neurobiological, cognitive, psychological and social consequences of this condition

2 or more unprovoked seizures occurring in a time frame of >24 hrs

Answer 3

EPILEPSY

Question 4

Disorder that manifests one or more specific seizure types and has a specific age of onset and prognosis

Answer 4

Epileptic syndrome

Question 5

The primary determinant of the type of MEDICATIONS the patient is likely to respond to

Answer 5

Seizure type

Question 6

Determines the TYPE OF PROGNOSIS one could expect

Answer 6

Epilepsy syndrome

Question 7

ILAE 2017 Classification of Seizure Types

Answer 7

FOCAL (aware or impaired consciousness)

• Motor onset (automatisms, myoclonic etc)
• Non-motor onset (autonomic, emotional etc)

GENERALIZED

• Motor (tonic-clonic, tonic, clonic etc)
• Non-motor (absence)

UNKNOWN

• Motor
• Non-motor
• Unclassified

Question 8

Partial seizure

Initial activation of a system of neurons LIMITED TO A PART OF ONE CEREBRAL HEMISPHERE

Answer 8

FOCAL SEIZURE

Focal seizure w/o impairment of consciousness

Focal seizure w/ impairment of consciousness (focal dyscognitive seizures)

Question 9

Clinical and EEG changes indicate synchronous involvement of ALL OR BOTH HEMISPHERES

Answer 9

GENERALIZED SEIZURES

Question 10

MC type of Benign Epilepsy Syndrome with Focal Seizures

Answer 10

• outgrown during adolescence
• focal seizure with buccal and throat tingling and tonic or clonic contractions of 1 side of the face, with drooling and inability to speak but with preserved consciousness and comprehension

Benign Epilepsy with Occipital Spikes

• Panayiotopoulos type
• Lennox-Gastaut type

Question 11

TRIAD of West Syndrome

2-12 months (infancy stage)

Answer 11

Infantile epileptic spasms
Developmental regression
EEG - HYPSARRHYTHMIA

Question 12

EEG in Benign Childhood Epilepsy with Centrotemporal Spike

Answer 12

broad based centrotemporal spikes

Question 13

8 mo old boy

(+) truncal flexion (as if doing sit ups) multiple times throughout the day

lost of ability to sit w/o support which he was able to do a month ago

EEG - high voltage, slow, chaotic background w/ multifocal spike

Answer 13

West Syndrome

Question 14

Later childhood (2-10 y/o)

complex partial seizure, visual auras, migraine headache

Answer 14

Lennox-Gastaut type

Question 15

Triad of Lennox-Gastaut type

Answer 15

developmental delay
multiple seizure type
polyspike bursts in sleep and slow background in wakefulness

Question 16

Early childhood

complex partial seizure with ictal vomiting

Answer 16

Panayiotopoulos type

Question 17

AED for Focal seizures and Epilepsies

Answer 17

Oxcarbazepine

Carbamazepine

Question 18

AED for Absence seizure

Answer 18

Ethosuximide

Lamotrigine
Valproic acid

Question 19

AED for Juvenile Myoclonic Epilepsy

Answer 19

Valproate

Lamotrigine

Question 20

AED for Lennox-Gastaut

Answer 20

Clobazam
Valproate
Topiramate
Lamotrigine

Question 21

AED for Infantile Spasms

Answer 21

ACTH

Question 22

AED for Dravet syndrome

Answer 22

Valproate + Benzodiazepine (Clobazam or Clonazepam)

Question 23

AED for Benign Myoclonic Epilepsy

Answer 23

Valproate

Benzodiazepines
Clonazepam
Lamotrigine
Topiramate

Question 24

AED for Severe Myoclonic Epilepsy

Answer 24

Topiramate
Clobazam
Valproate
Zonisamide

Question 25

AED for Partial and Secondary Generalized Tonic and Clonic Seizures

Answer 25

Oxcarbazepine Levetiracetam Carbamazepine Valproic acid ``` Phenobarbital Topiramate Lamotrigine Clobazam Clonazepam ```

Question 26

generalized < 15 minutes no recurrence in the 1st 24 hours absent focal signs in the post-ictal period

Answer 26

Simple Febrile Seizure (70-75%) MC seizure disorder during childhood

Question 27

focal > 15 minutes recurrence in the 1st 24 hours (+) focal signs in the post-ictal period

Answer 27

Complex Febrile Seizure

Question 28

Lumbar puncture should be performed in all patients below _______ for a first febrile seizure

Answer 28

18 mos (1 year and 6 mos)

Question 29

When to do lumbar tap?

Answer 29

ALL infants <6 mo of age who present with fever and seizure or if the child is ill-appearing or at any age if there are clinical signs or symptoms of concer Option in a child 6-12 mo of age who is deficient in Hib and Strep pneumoniae immunizations

Question 30

Risk factors for recurrence of febrile seizures

Answer 30

MAJOR <1 y/o duration of fever < 24 hrs fever 38 - 39 C ``` MINOR family hx of febrile seizures family hx of epilepsy complex febrile seizure daycare male gender lower serum sodium at time of presentation ```

Question 31

In patients developing febrile status epilepticus, what viral infection is most commonly associated in 1/3 of the cases?

Answer 31

HHV 6 and HHV 7

Question 32

Continuous seizure activity or recurrent seizure activity w/o regaining of consciousness > 5 minutes

Answer 32

STATUS EPILEPTICUS

Question 33

Status epilepticus that has FAILED to RESPOND to therapy usually with at least 2 medications (benzodiazepine and another medication)

Answer 33

REFRACTORY STATUS EPILEPTICUS

Question 34

Initial and Emergent therapy for Status Epilepticus

Answer 34

Diazepam or Lorazepam -- in 3-5 mins anticipate for response Phenytoin/Fosphenytoin and Phenobarbital - if after 5 minutes may recurrence pa din Valproate and Levetiracetam - if wala pa din

Question 35

Only drug that may be used for benign infantile seizures

Answer 35

Phenobarbital

Question 36

Lumbar puncture indications for first febrile seizure

Answer 36

all patients <18 mos (+) clinical signs of meningitis

Question 37

Greatest risk factor for occurrence of subsequent

Answer 37

Neurodevelopmental abnormalities

Question 38

1st step in management of status epilepticus

Answer 38

securing airway breathing circulation

Question 39

Most commonly associated viral infections with febrile status epilepticus

Answer 39

HHV 6 | HHV 7

Question 40

ABSOLUTE contraindications to a lumbar puncture

Answer 40

signs of increased ICP local infection at desired punctured site radiological signs of obstructive hydrocephalus, cerebral edema or herniation, (+) intracranial lesion or midline shift

Question 41

RELATIVE contraindications to a lumbar puncture

Answer 41

signs of shock, sepsis, hypotension coagulation defects focal neurologic defect GCS <8 epileptic seizure

Question 42

Recommended treatment for Neisseria meningitidis invasive infections in neonate

Answer 42

Cefotaxime

Question 43

Most frequently identified symptom in meningococcemia

Answer 43

Fever