Special Seizure Consideration

Question 1

What is the most common cause of first type seizures in pediatric age group?
● A. Febrile
● B. Hydrocephalus
● C. Electrolyte imbalance
● D. Vascular event
● E. Idiopathic

Answer 1

A. Febrile

Question 2

Prophylactic antiepileptic drugs reduce the incidence of late post-traumatic epilepsy by how much?
● A. One-fourth
● B. One-third
● C. Half
● D. No effect
● E. Increase the incidence by drug resistance

Answer 2

D. No effect

Question 3

What is the most common cause of nonepileptic seizures?
● A. Psychogenic
● B. Basilar migraine
● C. Cardiac arrhythmias
● D. Cyclic vomiting syndrome
● E. Dyskinesias

Answer 3

A. Psychogenic

Question 4

According to the definition of status epilepticus, seizure lasting more than how many minutes warrants management according to status epilepticus protocol?
● A. 1
● B. 3
● C. 5
● D. 30
● E. 60

Answer 4

C. 5

Question 5

What is the most common cause of status epilepticus?
● A. Low levels of antiepileptic drugs
● B. Metabolic
● C. Hypoxia
● D. Tumor
● E. Cerebrovascular event

Answer 5

A. Low levels of antiepileptic drugs

Question 6

What is the first-line treatment for status epilepticus?
● A. Benzodiazepine
● B. Fosphenytoin
● C. Phenytoin
● D. Valproic acid
● E. Phenobarbital

Answer 6

A. Benzodiazepine

Question 7

What is the drug of choice for myoclonic status epilepticus?
● A. Benzodiazepine
● B. Fosphenytoin
● C. Phenytoin
● D. Valproic acid
● E. Phenobarbital

Answer 7

D. Valproic acid

Question 8

Antiseizure medication can be tapered off in which of the following cases after 7 days?
● A. Penetrating brain injury
● B. Development of late PTS
● C. Prior seizures history
● D. Patient undergoing craniotomy
● E. Linear skull fracture

Answer 8

E. Linear skull fracture

Question 9

The etiologies of first-time seizure include neurologic insult (stroke, head trauma, CNS infection, birth asphyxia), underlying CNS abnormality (congenital, degenerative, CNS tumor, hydrocephalus, AVM), acute systemic metabolic disturbance (electrolyte disorders, alcohol withdrawal, cocaine toxicity, opioids, phenothiazine antiemetics), and idiopathic. Which of the following neurologic insult is the most common cause of
first-onset seizure in pediatric population?
● A. CNS infection
● B. Birth asphyxia
● C. Febrile seizures
● D. Idiopathic
● E. Head trauma

Answer 9

C. Febrile seizures

Question 10

An adult person comes in neurosurgical OPD with history of new-onset seizure in the absence of obvious cause like alcohol withdrawal. His/her MRI with and without contrast and systemic workup come out to be negative. How this adult should
be followed up?
● A. No need for further follow-up in absence of seizure
● B. Follow-up after 6 months with repeat MRI which if found negative then no need for further follow-up
● C. Further follow-up if seizure occurs again
● D. Further follow-up after 6 months with repeat MRI, then at 1 year with repeat MRI, and possibly at 2 years to rule out tumor in brain
● E. Start antiepileptic medication and follow-up after 6 months

Answer 10

D. Further follow-up after 6 months with repeat MRI, then at 1 year with repeat MRI, and possibly at 2 years to rule out tumor in brain

Question 11

Post-traumatic seizures (PTS) can occur in patients after head injury. These can adversely affect the patient as it may elevate ICP, may adversely affect blood pressure or oxygen delivery, and may worsen other injuries. Hence, antiseizure medication (levetiracetam, phenytoin, carbamazepine) should be started within 24 hours in patients meeting high-risk criteria for PTS. These high-risk criteria include the following except?
● A. ASD hematoma, EDH, ICH, or open depressed skull fracture with parenchymal injury
● B. No history of significant alcohol abuse
● C. Seizures within the first 24 hours after injury
● D. Penetrating head injury
● E. GCS less than 10 or cortical contusion

Answer 11

B. No history of significant alcohol abuse

Question 12

Antiseizure medications (ASMs) are given for 1 week and then tapered as it prevents from early-onset post-traumatic seizure (within 7 days of injury). However, ASMs are continued for 6 to 12 months in patients after head injury in which of the following conditions?
● A. Penetrating head injury
● B. Development of late PTS (a seizure lasting more than 7 days following head injury)
● C. Prior seizure history
● D. Patients undergoing craniotomy
● E. All of the above

Answer 12

E. All of the above

Question 13

Alcohol withdrawal seizure can occur within 7 to 30 hours of cessation or reduction of alcohol intake in habituated drinkers. These seizures are treated with diazepam or lorazepam if they continue for 3 to 4 minutes or phenytoin. What is the loading dose (mg/kg) of phenytoin for such patients?
● A. 16
● B. 18
● C. 20
● D. 22
● E. 24

Answer 13

B. 18

Question 14

Differentials of nonepileptic seizures include psychologic disorders (anxiety, dissociative, psychonic, impulse control, attention deficit), cardiovascular disorders (syncope, cardiac ar-
rythmias, TIAs), migraine syndrome, movement disorders (tremors, dyskinesias, tic), parasomnias with sleep-related disorders, and others like malingering or cognitive disorders. Following are features associated with nonepileptic seizure disorder except?
● A. Manifestations altered by distraction
● B. Intermittent arrhythmic and out-of-phase convulsive activity
● C. Nonfluctuating intensity and severity during seizure
● D. Bilateral motor activity with preserved consciousness
● E. Absence of stereotypy

Answer 14

C. Nonfluctuating intensity and severity during seizure

Question 15

A febrile seizure is said to be a seizure in infants or children associated with fever with no defined cause and unaccompanied by acute neurologic illness. Which statement is most appropriate regarding management of these seizures?
● A. There are recommendations for prescribing antiseizure medication in these cases
● B. Phenobarbital can be used with no effect on kid’s IQ
● C. Valproate has no serious risks in the kids younger than 2 years
● D. Recurrence of febrile seizures in children can be reduced using diazepam 0.33 mg/kg per oral every 8 hours during a febrile episode and continuing until 24 hours after the fever subsides
● E. None of the above

Answer 15

D. Recurrence of febrile seizures in children can be reduced using diazepam 0.33 mg/kg per oral every 8 hours during a febrile episode and continuing until 24 hours after the fever subsides

Question 16

Status epilepticus is a continuous seizure activity or more than equal to two sequential seizures without full recovery of consciousness between seizures for more than 30 minutes. The goal of treatment in such patients is rapid termination of clinical and electrical seizure activity as continuation of seizure activity for more than 30 minutes can cause permanent neurologic deficit. What is the most common cause of status epilepticus?
● A. Low level of prescribed ASM in a patient with a seizure disorder
● B. Remote symptomatic cause
● C. Stroke
● D. Metabolic disturbance
● E. Hypoxia

Answer 16

A. Low level of prescribed ASM in a patient with a seizure disorder

Question 17

Treatment of status epilepticus is divided into four phases with phase 1 comprising from 0 to 5 minutes, phase 2 from 5 to 20 minutes, phase 3 from 20 to 40 minutes, and phase 4 from 40 to 60 minutes. First 0 to 5 minutes phase is called as
stabilization phase. Following are the components of this phase except?
● A. ABC, that is, assessment and correction of airway, breathing, circulation with adequate oxygenation and arterial blood gases (ABG) monitoring
● B. 50 mL of dextrose 50 is given by IV push before giving 100 mg thiamine IV
● C. Baseline investigation is sent for with start of IV fluid and neurologic examination
● D. Initial additional measures include EEG monitoring if possible, head CT without contrast, correction of any suspected electrolyte imbalance, and CNS sampling for suspected CNS infection with start of antibiotics
● E. General medication for unknown suspected poisoning cases includes naloxone 0.4 mg IV for narcotics, bicarbonate to counter acidosis, and for neonates less than 2 years, pyridoxine 100 mg IV push is given

Answer 17

B. 50 mL of dextrose 50 is given by IV push before giving 100 mg thiamine IV

Question 17

During the second phase of status epilepticus treatment, which last from 5 to 20 minutes, benzodiazepine is the drug of choice with IM midazolam or IV lorazepam or IV diazepam in
dosage of 10 mg (for adult) or 0.1 mg/kg/dose or 0.15 to 0.2 mg/kg/dose given, respectively, once. If all the above meds are unavailable or contraindicated, then IV phenobarbital (15 mg/
kg/dose) or rectal diazepam (0.2 to 0.5 mg/kg) or intranasal midazolam or buccal midazolam can be given. What is the component of the second therapy phase which lasts from 20 to 40 minutes?
● A. IV phosphenytoin
● B. IV valproic acid 40 mg/kg/dose up to max 3,000 mg/dose
● C. IV levetiracetam 60 mg/kg/dose up to max 4,500 mg/dose
● D. IV phenobarbital 15 mg/kg/dose
● E. All of the above

Answer 17

E. All of the above