Epilepsy

Question 1

Status epilepticus
Stage 1 first 30 minutes

Answer 1

Benzodiazepines (IV lorazepam , Buccal midazolam, IV or rectal diazepam)
no response give another dose

Question 2

Status epilepticus
Stage 2 (30-120 minutes)

Answer 2

Established status epilepticus
Treat with IV antiepileptic drugs (Phenytoin, phenobarbital or valproate)

Question 3

Status epilepticus
Stage 3 (<120 minutes)

Answer 3

Refractory status epilepticus
General anesthesia (Propofol, midazolam or thiopental/pentobarbital)

Question 4

Status epilepticus
After 24 hours

Answer 4

Super refractory status epilepticus
status epilepticus which has continued or recurred despite therapy with general anesthesia for 24 hours or more

Question 5

Most common cause of seizure attack in epilepsy:

Answer 5

• low antiepileptic drug (AED) level (MC)
  Sleep deprivation is other cause
  -do not forget hypoglycemia as a cause of seizure attack

Question 6

Absence seizure treatment

Answer 6

Ethosuximide

Question 7

Generalized epilepsy tx

Answer 7

Na valproate (but other can be used)
note that some drugs can decrease seizure threshold such as
Bupropion and fluoroquinolone

Question 8

Safe in pregnancy epileptic drug

Answer 8

Levetiracetam

Question 9

Status epilepticus:

Answer 9

A seizure that lasts longer than 5 minutes, or having more than 1 seizure within a 5
minutes period, without returning to a normal level of consciousness between
episodes

Question 10

A patient has a sudden onset of seizure, he is
medically free, has no family history of epilepsy, and no history of recent infection, he
has never had any previous episodes of seizures or loss of consciousness, he is not on
any medications, electrolytes and other blood tests were all normal, what is the next
investigation that should be done for this patient?

Answer 10

Brain imaging

ECG if the case is syncope

Question 11

Patient came with seizure and History of
multiple sexual partners in past 6 years, what
investigation you will order?

Answer 11

• Syphilis (tertiary syphilis)

Question 12

20-year-old female presented to ER with status
epilepticus for 5 min, with IV access, what is the frst line?

Answer 12

IV Lorazepam

Buccal midazolam if no iv access

Question 13

25-year-old female known case of epilepsy came with generalized tonic clonic seizure for 35 minutes and started on 20 mg IV lorazepam but did not respond, what are you going to give her next?

Answer 13

IV Phenytoin

Question 14

Pediatric patient with manifestation of absence
seizure, what is the appropriate treatment?

Answer 14

Ethosuximide

Question 15

Patient want to stop smoking, he has HTN and epilepsy, what is the contraindicated drug?

Answer 15

Bupropion