Seizures in Adults

Question 1

characteristics of acute symptomatic seizures

Answer 1

has an identifiable proximate cause
treatment is directed towards the underlying cause
not necessarily characterized by a tendency for recurrence
epilepsy can be w acss

Question 2

definition of epilepsy

Answer 2

• at least two unprovoked (or reflex) seizures occurring >24 h apart
• one unprovoked (or reflex) seizure and probability of further seizures after 2 unprovoked seizures over the next 10 years
• diagnosis of epilepsy syndrome

Question 3

at least 2 seizures occurring over 5-6 hours different from their usual pattern and not categorized as status epilepticus

Answer 3

acute repetitive seizures

Question 4

t1 and t2 for tonic clonic SE

Answer 4

t1: 5 min
t2: 30 min

Question 5

t1 and t2 for focal se with impaired consciousness

Answer 5

t1: 10 min
t2: >60 min

Question 6

t1 and t2 for absent status epilipticus

Answer 6

t1: 10-15 min
t2: unknown

Question 7

categories of se

Answer 7

refractory (1st and 2nd line)
super-refractory (24 hrs, 3rd line)
prolonged refractory (7 days, no anesthetics)
prolonged super-refractory se (7 days, ongoing anesthetics)

Question 8

3 requirements for seizure

Answer 8

pathologically excitable neurons
increase in excitatory activity (glutamate)
decrease in inhibitory activity (gaba)

Question 9

what is a generalized seizure

Answer 9

originate at some point within and rapidly engage bilaterally distributed networks

not necessarily entire cortex

Question 10

what are focal seizures

Answer 10

originate within networks limited to one hemisphere

Question 11

types of generalized seizure

Answer 11

absence (behavioral arrest)
myoclonic (jerking and/or falling)
primarily generalized tonic clonic

Question 12

most common onset of seizure

Answer 12

epigastric aura

Question 13

most common cause of intractable epilepsy

Answer 13

mesial temporal sclerosis

on MRI

• hippocampal volume loss
• hippocampal hyperintensity (gliosis)

Question 14

drugs to be avoided in generalized genetic (idiopathic) epilepsy

Answer 14

traditional na channel blockers: phenytoin, carbamazepine, oxcarbazepine
a2 subunit ca channels: gabapentin and pregabalin
gaba i: vigabatrin, tiagabine

Question 15

first line treatments for

adults, children, and elderly adults with focal seizures

Answer 15

carbamazepine
lamotrigine
levetiracetam
oxcarbazepine
sodium valproate

Question 16

first line treatment for adults and children with gtc seizures

Answer 16

sodium valproate
carbamazepine
lamotrigine
oxcarbazepine

Question 17

first line treatment for absence seizure

Answer 17

ethosuximide
sodium valproate
lamotrigine

Question 18

first line treatment for bects

Answer 18

carbamazepine

lamotrigine

Question 19

first line treatment for jme

Answer 19

valproic acid
levetiracetam
lamotrigine
topiramate

Question 20

first line treatment for tonic seizures

Answer 20

sodium valproate

Question 21

first line treatment for myoclonic seziures

Answer 21

levetiracetam
sodium valproate
topiramate

Question 22

indications for medical therapy

Answer 22

second seizure occurs
eeg shows interictal epileptiform abnormalities
identified persisting cause of seizures
first seizure is SE
psychosocial matters

Question 23

t/f efficacy is based on eeg

Answer 23

false, it’s based on clinical response