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A. Block D Neurology > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

When defining the term epilepsy we need to understand 2 terms; provoked seizure and unprovoked seizure. In relation to epilepsy what does unprovoked seizure mean?

1 - cause of seizure is known
2 - cause of seizure is unknown
3 - cause of seizure or the precipitating factor is unknown
4 - all of the above

A

3 - cause of seizure or the precipitating factor is unknown

  • no medically reversible cause (alcohol, blood glucose) can be identified
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2
Q

What is a provoked seizure?

1 - cause of seizure is known
2 - cause of seizure is unknown
3 - cause of seizure is identified but not the precipitating factor
4 - cause of seizure or the precipitating factor is known

A

4 - cause of seizure or the precipitating factor is known

  • diabetes, neurological disorder, alcohol withdrawal
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3
Q

How many unprovoked (no known cause or precipitating factor) seizures need to occur before a patient is diagnosed with epilepsy?

1 - 1
2 - >2
3 - >4
4 - >10

A

2 - >2
- MUST be separated by >24 hours

Diagnosis also includes those who have had one seizure and and are >60% risk of subsequent seizures.

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4
Q

What % of the population are affected by epilepsy?

1 - 0.1 - 1%
2 - 10-15%
3 - 15-30%
4 - 30-50%

A

1 - 0.1 - 1%

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5
Q

Which 2 of the following are said to be the cause of seizures?

1 - too much neuronal excitation
2 - toxicity of neurotransmitters
3 - lack of neurotransmitters
4 - too much inhibitory neurotransmitter stimulus

A

1 - too much neuronal excitation
- increased glutamate binding NMDA receptors

4 - too much inhibitory neurotransmitter stimulus
- too much GABA binding GABA receptors

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6
Q

Even in patients with a diagnosis of epilepsy, who are typically well controlled, they can still experience seizures. Which of following are causes of seizures in patients who are well controlled?

1 - inconsistent use of anti-epileptic medication
2 - lifestyle changes (increased stress, sleep deprivation, alcohol use)
3 - new medications / supplements interacting with anti-seizure medication
4 - estrogen supplements increase metabolism of lamotrigine (lowering serum levels) and pregnancy
5 - Infection
6 - all of the above

A

6 - all of the above

  • inconsistent use of anti-epileptic medication is typically the most common cause
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7
Q

Are the seizures always of the vigorous shaking kind?

A
  • no
  • seizures can be brief and nearly undetectable symptoms to periods of vigorous shaking and convulsion
  • all depends on part of brain affected
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8
Q

In epilepsy we know that seizures are caused by abnormal firing of the neurons in the brain. Which part of the brain is generally affected in up to 60% of cases?

1 - frontal
2 - parietal
3 - occipital
4 - temporal

A

4 - temporal
- presents with lots of symptoms, including epigastric rising, olfactory/gustatory hallucinations, autonomic, affective, deja-vu; motor arrest and absence prominent (>30 seconds), automatisms, automatic speech, contralateral dystonia

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9
Q

What is an automatism?

1 - voluntary movements following a seizure
2 - involuntary movement following a seizure
3 - coordinated involuntary motor activity
4 - voluntary coordinated movement

A

3 - coordinated involuntary motor activity

  • auto = means happens automatically without control
  • typically occur during the seizure
  • typically associated with amnesia and impaired awareness
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10
Q

A prodrome typically occurs before a seizure, but what is a prodrome?

1 - drowsy, confused, psychotic. Bitten tongue, lost continence
2 - feeling, sensations, changes in behaviour hours or days before the event
3 - actual event (may need witness description)
4 - immediately prior (not always present)

A

2 - feeling, sensations, changes in behaviour hours or days before the event

  • a lot of the time it can be family or friends who aware of the changes
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11
Q

There are different things that can occur in seizures. Which of the following is the definition of preictal/aura ?

1 - drowsy, confused, psychotic. Bitten tongue, lost continence
2 - feeling, sensations, changes in behaviour hours or days before the event
3 - actual event (may need witness description)
4 - immediately prior (not always present)

A

4 - immediately prior (not always present)

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12
Q

There are different things that can occur in seizures. Which of the following is the definition of Ictal?

1 - drowsy, confused, psychotic. Bitten tongue, lost continence
2 - feeling, sensations, changes in behaviour hours or days before the event
3 - actual event (may need witness description)
4 - immediately prior (not always present)

A

3 - actual event (may need witness description)
- typically associated with amnesia

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13
Q

What is post-ictal ?

1 - drowsy, confused, psychotic. Bitten tongue, lost continence
2 - feeling, sensations, changes in behaviour hours or days before the event
3 - actual event (may need witness description)
4 - immediately prior (not always present)

A

1 - drowsy, confused, psychotic. Bitten tongue, lost continence

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14
Q

Some patients may experience a preceding prodrome that can last hours to days prior to a seizure, typically of the temporal lobe causing a change in mood or behaviour. They can also experience an aura. Typically what do patients with an aura experience?

1 - strange feeling in the gut
2 - deja vu
3 - strange smells
4 - flashing lights
5 - all of the above

A

5 - all of the above

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15
Q

What is the term given in epilepsy when a seizure affects both hemispheres?

1 - unprovoked
2 - generalised
3 - systemic
4 - central

A

2 - generalised

Typically last 60-90 seconds

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16
Q

Can partial / focal seizures develop into generalised seizures?

A

yes
- called a secondary generalised seizure

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17
Q

Does a aura suggest a focal/partial or generalised seizure?

A
  • focal seizure

This is because it is likely to effect only a small part of the brain

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18
Q

In epilepsy we know that seizures are caused by increased glutamate (excitatory) or decreased GABA (inhibitory) that causes abnormal firing of the neurons in the brain. In up to 60% of cases it generally affected the temporal lobe, but can also spread/occur where?

1 - frontal
2 - occipital
3 - cerebellum
4 - all of the above

A

1 - frontal
- typically affects the frontal as well

  • can affect both hemispheres
  • parietal and occipital (rare)
  • where seizures occurs affects how the patient presents
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19
Q

In epilepsy, seizure can last for longer periods. If the seizure lasts >5 minutes in duration, what is this called?

1 - status epilepticus
2 - status provoctus
3 - status criticalis
4 - partial epilepticus

A

1 - status epilepticus (SE)
- latin for continuous state of seizure

There are known and unknown causes of SE, but ethanol overuse can be linked to both

See picture for other causes

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20
Q

Status epilepticus is when a seizure lasts longer >5 minutes in duration. Why is this serious?

1 - can increase risk of subsequent seizures
2 - increases risk of drug toxicity
3 - increases risk of self harm
4 - medical emergency

A

4 - medical emergency

  • typically tonic-clonic affecting both hemispheres
  • can lead to permanent brain damage and death
  • mortality is between 10-20%
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21
Q

Which of the following groups are most at risk of status epilepticus?

1 - Caucasian
2 - African American
3 - Eastern European
4 - Eastern Asians

A

2 - African American

Most at risk of Sudden Unexplained Death In Epilepsy (SUDEP)

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22
Q

Why is status epilepticus so dangerous?

1 - more difficulty to stop seizure
2 - hyper metabolic (low ATP and increased lactate)
3 - increased Ca2+ channels open due to glutamate excitability
4 - all of the above

A

4 - all of the above

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23
Q

Does status epilepticus always causes a convulsive type present with shaking and muscle contractions (tonic/clonic seizures)?

A
  • No

Can present as delirium or coma like

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24
Q

Due to the seriousness of Status epilepticus, what medication can patients often be given to try and stop the seizure?

1 - typical psychotics
2 - benzodiazepines
3 - antiepileptics
4 - antidepressants

A

2 - benzodiazepines
- increases effects of GABA to try and control patients seizure

  • administered by intravenously, mucosal or rectal
  • Do ABCDE and ensure airway is clear, may need anaesthetics input
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25
Q

What is the 1st line treatment for status epilepticus?

1 - diazepam
2 - carbamazepine
3 - lorazepam
4 - phenytoin

A

3 - lorazepam

  • can also try diazepam rectally
  • can also try midazolam buccal
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26
Q

Lorazepam is the 1st line treatment for status epilepticus. However, if a patient continues to have seizures, what medication should they be given?

1 - diazepam
2 - carbamazepine
3 - more lorazepam
4 - phenytoin

A

4 - phenytoin
- need to monitor BP and ECG

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27
Q

If a patient has been given lorazepam, and then phenytoin and the patient remains in status epilepticus for 60-90 minutes, what should the next treatment option be?

1 - double lorazepam and phenytoin dosages
2 - give rectal diazepam
3 - consider anaesthesia (propofol)
4 - all of the above

A

3 - consider anaesthesia (propofol)
- patient will also need to be intubated with continuous EEG monitoring in ICU

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28
Q

In a patient with status epilepticus, organise the emergency management of the patient from the below options:

1 - thiamine and glucose administered if malnourished
2 - IV access and bloods taken
3 - anaesthesia (propofol) with continuous EEG in ICU
4 - open and secure airway
5 - Oxygen @ 100% + suction as required
6 - lorazepam given as IV bolus
7 - correct hypotension as required

A

4 - open and secure airway
5 - Oxygen @ 100% + suction as required
2 - IV access and bloods taken
6 - lorazepam given as IV bolus
1 - thiamine and glucose administered if malnourished
7 - correct hypotension as required
3 - anaesthesia (propofol) with continuous EEG in ICU

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29
Q

If a patient has status epilepticus they may need to be given glucose and B vitamins (Pabrinex) if ethanol is a suspected cause. But would we give the glucose or vitamin B 1st?

A
  • Vitamin B

Reduces risk of wernicke’s encephalopathy

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30
Q

A generalised seizure is when both hemispheres are affected. There are subcategories of how the generalised seizures present. Which of the following is NOT a form of generalised seizure?

1 - tonic
2 - atonic
3 - complex partial
4 - clonic
5 - tonic-clonic
6 - myoclonic
7 - absence

A

3 - complex partial

  • tonic = stiff and flexed, patients fall backwards
  • atonic = relaxed, patients fall forwards
  • clonic = violent convulsions
  • tonic-clonic = mixture
  • myoclonic = small muscle twitches
  • absence = patient spaces out
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31
Q

A generalised seizure is when both hemispheres are affected. There are subcategories of how the generalised seizures present. Which of the this subcategories is most common?

1 - tonic
2 - atonic
3 - clonic
4 - tonic-clonic
5 - myoclonic
6 - absence

A

4 - tonic-clonic
- tonic = stiffening
- clonic = twitching or jerking

  • phases of violent convulsions mixed with relaxed muscles
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32
Q

What is the 1st line treatment for a patient having myoclonic seizures (myo = one, clonic = twitching or jerking), which can present with a muscle twitches to whole body spasms that can be brief?

1 - Carbamazepine
2 - Phenytoin
3 - Diazepam
4 - Levetiracetam
5 - Sodium Valproate

A

5 - Sodium Valproate

  • 2nd line is Levetiracetam
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33
Q

In a generalised (affecting the the whole brain) tonic-clonic seizure, there is a tonic phase (stiffening of the body) followed by a clonic phase (violent/jerking of the body). In the image below which is tonic and which is clonic?

A

A = tonic
- tonic (stiff) phase due to prolonged depolarization due to loss of GABA inhibition
- affected tissue cannot relax

B = clonic
- clonic (jerk) phase due to some neuronal repolarization
- following inactivity all tissues are stimulated quickly at one

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34
Q

What is the 1st line medication for a patient who is having generalised tonic-clonic seizures?

1 - Carbamazepine
2 - Phenytoin
3 - Diazepam
4 - Levetiracetam
5 - Sodium Valproate

A

5 - Sodium Valproate

  • 2nd line could be Carbamazepine or Levetiracetam
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35
Q

What is an absence seizure?

1 - a seizure where patients lose consciousness
2 - a seizure where patients lose awareness of their surrounding for a period of time
3 - a seizure that has a stiff followed by involuntary actions
4 - combination of all of the above

A

2 - a seizure where patients lose awareness of their surrounding for a period of time
- looks like patient may be day dreaming
- dysfunction between cortex and thalamus

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36
Q

What is the 1st line medication for a patient who is having absence seizures?

1 - Carbamazepine
2 - Phenytoin
3 - Diazepam
4 - Levetiracetam
5 - Sodium Valproate

A

5 - Sodium Valproate

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37
Q

In all types of generalised seizures do patients lose consciousness?

A
  • yes
  • can be brief or for prolonger periods
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38
Q

In epilepsy seizures can be focal, affecting one specific location such as a lobe or one hemisphere, also called partial seizures of generalised where the the whole brain is affected. In focal / partial seziures they can be simple of complex partial seizures. Which of these does the patient typically remain concious?

A
  • simple partial seizures
  • patient is typically aware of what is happening and will remember
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39
Q

In epilepsy seizures can be focal, affecting one specific location such as a lobe or one hemisphere, also called partial seizures of generalised where the the whole brain is affected. In focal / partial seziures they can be simple of complex partial seizures. In simple partial seizures the patient is generally concious, is aware and will remember what happened. Which of the following typically occur during a simple partial seizures?

1 - strange sensations (smells, tastes etc..)
2 - jerking of muscles
3 - jacksonian march
4 - all of the above

A

4 - all of the above
- jacksonian march = small jerking of muscles spreads to surrounding areas increasing the jerking movements

40
Q

In epilepsy seizures can be focal, affecting one specific location such as a lobe or one hemisphere, also called partial seizures of generalised where the the whole brain is affected. In focal / partial seziures they can be simple of complex partial seizures. In complex partial seizures the patient is generally unconcious. Which of the following typically occur during a complex partial seizures?

1 - loss of consciousness
2 - impaired awareness
3 - memory may be impaired
4 - all of the above

A

4 - all of the above

41
Q

What is the 1st line medication for a focal (partial) epileptic seizure?

1 - Carbamazepine
2 - Phenytoin
3 - Diazepam
4 - Levetiracetam
5 - Sodium Valproate

A

1 - Carbamazepine

  • Levetiracetam and Sodium Valproate could also be given
42
Q

In epilepsy, in animals at least what does the Kindling hypothesis relate to?

1 - decreased seizures results in shorter duration of seizures
2 - increased seizures results in shorter duration of seizures
3 - increased seizures results in longer duration of seizures
4 - decreased seizures results in shorter duration of seizures

A

3 - increased seizures results in longer duration of seizures

  • seizure leads to more seizures, this continues until the number of seizures plateaus and the brain burns out
  • BUT we do not know if this occurs in humans
43
Q

When conducting a history on a patient with suspected epilepsy, which of the following are risk factors that we need to ask about?

1 - family history
2 - duration and number of seizures
3 - medical history (strokes, diabetes)
4 - social history (drugs, alcohol)
5 - all of the above

A

5 - all of the above

44
Q

The aetiology of epilepsy has a huge list, which can cause provoked (known cause) seizures. Which 4 of the following are the most common causes of provoked seizures in adults?

  • Antenatal / intrauterine – remote infection, trauma, hypoxia
  • Genetic
  • Electrolyte disturbances
  • Infection
  • Medications
  • Drugs
  • Tumours
  • Trauma
  • Congenital disorders
  • Neurodegenerative conditions
  • Stroke
A
  • stroke
  • tumour
  • trauma
  • infection
45
Q

The aetiology of epilepsy has a huge list, which can cause provoked (known cause) seizures. Which 4 of the following are the most common causes of provoked seizures in children?

  • Antenatal / intrauterine – remote infection, trauma, hypoxia
  • Genetic
  • Electrolyte disturbances
  • Infection
  • Medications
  • Drugs
  • Tumours
  • Trauma
  • Congenital disorders
  • Neurodegenerative conditions
  • Stroke
A
  • genetic
  • metabolic disorders
  • trauma
  • infection
46
Q

What % of epilepsy is accounted for by genetics?

1 - 4%
2 - 20%
3 - 30%
4 - 40%

A

4 - 40%
- associated with multiple rare variants
- could also be part of a genetic syndrome, such as tubular sclerosis

47
Q

Monogenic epilepsy is when there is 1 gene that causes epilepsy. This is rare accounting for 1-2% of epilepsy and is transmitted in an autosomal recessive fashion (need a mutated gene from mum and one from dad). What is the most common genetic abnormality cause?

1 - GPCRs mutations
2 - ion channels involved in excitability
3 - ligand gates channels
4 - lack of acetylcholinesterase

A

2 - ion channels involved in excitability
- essentially this causes over activity
- called channelopathies

48
Q

Can a genetic diagnosis help with surgery?

A
  • yes
  • if we know there is a genetic cause, surgery would be high risk and pointless
  • we can also tailor medication
49
Q

Once a patient has had a seizure, typically how quickly should they be seen by a neurologist?

1 - immediately
2 - <24h
3 - <1 week
4 - <2 weeks

A

4 - <2 weeks

50
Q

If a patient has an acute seizure and epilepsy is suspected, what are the 3 most basic tests a patient may undergo to try and diagnose why they had the seizure (before doing an EEG)?

1 - blood test, imaging, lumbar puncture
2 - blood test, cranial nerve examination, imaging
3 - blood test, cranial nerve examination, history
4 - imaging, cranial nerve examination, imaging

A

1 - blood test, imaging, lumbar puncture

  • blood tests (infection, blood glucose)
  • lumbar puncture (rule out infection)
  • imaging (rule out stroke/tumour)

ECG should also be performed to rule out cardiac problems such as prolonged QT-interval

51
Q

Seizures in epilepsy can be provoked or unprovoked.

1 - Provoked immediate (known cause)

  • toxin, medication, metabolic
  • recurrence is low in the absence of the provoking factor
  • acute symptomatic (close to the time of a brain insult)
  • recurrence is 80% less likely than a remote symptomatic seizure

2 - Unprovoked (no known cause)

  • remote symptomatic (pre-existing brain injury)
  • associated with an epileptic syndrome

Why is it important to identify if the seizure is provoked or unprovoked?

A
  • if we can identify a cause (provoked) we can treat this
  • important for prognosis and treatment
52
Q

Seizures are common in epilepsy, but it is important to differentiate if this is an epileptic seizure or not. Which of the following would NOT be considered in a differential for epilepsy?

epileptic seizure = abnormal firing in brain
non-epileptic seizure = no abnormal firing in brain

1 - non-epileptic
2 - syncope (can have twitches)
3 - sleep attack
4 - cataplexy (loss of muscle tone)
5 - migraine
6 - transient ischaemic attack
7 - stroke

A

7 - stroke

53
Q

If a patient has non-epileptic seizures what is the mainstay of treatment?

epileptic seizure = abnormal firing in brain
non-epileptic seizure = no abnormal firing in brain

1 - medication
2 - electroconvulsive therapy
3 - psychotherapy
4 - surgery

A

3 - psychotherapy
- 10-15% of patients with epilepsy can have non-epileptic attacks

54
Q

It is important to be able to differentiate between epileptic and non-epileptic seizures. What is the key difference between epileptic and non-epileptic seizures?

epileptic seizure = abnormal firing in brain
non-epileptic seizure = no abnormal firing in brain

1 - if electrical activity in the brain is dysfunctional
2 - age of the patient
3 - duration of symptoms
4 - all of the above

A

1 - if electrical activity in the brain is dysfunctional

Non-epileptic seizures can be caused by:

  • Fever
  • Infection
  • Electrolyte imbalance
  • Withdrawal from drugs or alcohol
  • Extremely low blood sugar
  • Brain damage from stroke, brain surgery, or head injury
55
Q

In an epileptic seizure are the eyes typically open?

A
  • yes
  • if patients eyes are closed and resistant to opening, likely this is a non-epileptic seizure

epileptic seizure = abnormal firing in brain
non-epileptic seizure = no abnormal firing in brain

56
Q

Which of the following are characteristics of a non-epileptic seizure?

epileptic seizure = abnormal firing in brain
non-epileptic seizure = no abnormal firing in brain

1 - 2/3 have prominent motor features
2 - there is a gradual onset that wax and wane lasting over 2 minutes
3 - patient is motionless unresponsiveness for over 5 minutesfollowing the non-epileptic seizure
4 - patient may not respond to drugs
5 - all of the above

A

5 - all of the above

57
Q

The babinski sign is used to asses neurological dysfunction.

  • negative babinski in >2 y/o all toes curl
  • negative babinski in <2/yo big toe curls up and other 4 toes curl down
  • positive babinski in >2/yo big toe curls up and other 4 toes curl down

Do patients with a tonic-clonic epileptic seizure and non-epileptic seizures have a positive babinski sign?

A
  • no
  • tonic-clonic epileptic seizure = positive Babinski
  • non-epileptic seizures = negative Babinski
58
Q

When trying to distinguish between a tonic-clonic epileptic seizure and non-epileptic seizures, which have no corneal reflexes?

epileptic seizure = abnormal firing in brain
non-epileptic seizure = no abnormal firing in brain

A
  • tonic-clonic epileptic seizure = no corneal reflex
  • non-epileptic seizures = have corneal reflex as the neuronal activity in the brian is not affected
59
Q

Do patients with a non-epileptic seizures have changes on an EEG?

epileptic seizure = abnormal firing in brain
non-epileptic seizure = no abnormal firing in brain

A
  • no as there is typically no abnormal neuronal activity
  • there will be muscle artefacts
60
Q

What is a convulsive seizure?

1 - patient faints and then shakes
2 - patient has seizure and remains unconscious
3 - patient has abnormal brain activity that causes autonomic abnormality
4 - all of the above

A

1 - patient faints and then shakes
- can be caused by cerebral hypoxia causing myoclonal jerks
- common referral to neurologist

61
Q

Which of the following is NOT one of the 3 steps to classify epilepsy?

1 - classify type of seizure (focal/partial vs generalised)
2 - classify type of epilepsy (provoked or seizure)
3 - duration of seizure
4 - diagnosis of epilepsy syndrome

A

3 - duration of seizure
- important in history taking, but not for classification

62
Q

Which of the following is the best time to conduct an EEG?

1 - Prodrome
2 - Preictal/aura
3 - Ictal
4 - Post-ictal

A

3 - Ictal
- essentially during the seizure
- EEG lasts 30-40 minutes, read at 10 second intervals

63
Q

To look at a patients seizures in real time, what technique can be used, and what part of the brain is monitored?

1 - ECG and cerebral cortex
2 - ECG and brain stem
3 - EEG and cerebral cortex
4 - EEG and brain stem

A

3 - EEG and cerebral cortex
- cerebral cortex as this is closest to monitors
- EEG lasts 30-40 minutes, read at 10 second intervals

64
Q

When considering different rhythms on an EEG, which 2 of the following would only be present during sleep?

1 - alpha
2 - beta
3 - theta
4 - delta

A

3 - theta
4 - delta

  • alpha and beta are only present when awake
65
Q

Does a normal EEG rule out epilepsy?

A
  • no, seizure could have passed and brain has returned to normal
  • depends on when the seizure was and soon EEG can be done following the seizure
66
Q

Epileptiform discharges are used to identify if a patient has epilepsy. What are epileptiform discharges?

1 - abnormal signals on an ECG characterised by large spike waves
2 - abnormal signals on an EEG characterised by large spike waves

A

2 - abnormal signals on an EEG characterised by large spike waves

67
Q

If a seizure is no longer happening, can epileptiform discharges still be detected to help diagnosis epilepsy?

A
  • yes, providing close to time of seizure otherwise neuronal activity returns to normal
  • called interictal (in between seizures) epileptiform discharges (IED)
68
Q

When trying to measure epileptiform discharges on an EEG to help diagnosis epilepsy, why is it important to ask about medication?

A
  • medication can affect action potentials and therefore the EEG trace
  • benzodiazepine can inhibit neuronal activity through GABA
69
Q

What is the only time an EEG rule out epilepsy?

1 - when we know the cause and precipitating factor
2 - when we know the full medical history and medication of the patient
3 - <30 minutes from a seizure occurring
4 - when a seizure is occurring

A

4 - when a seizure is occurring
- if epileptiform discharges are not present (uncommon EEG patterns characterised by lateralised or generalised; periodic or near periodic; or spike, spike-wave, or sharp-wave complex presentations throughout most or all of the recording) then epilepsy is unlikely the cause of the seizure

70
Q

EEGs are not great at detecting epileptiform discharges. Therefore, clinicians can ask patients to do certain things in an attempt to induce a seizure. Which of the following is NOT a common methods of doing this?

1 - sleep deprivation
2 - hyperventialtion
3 - alcohol consumption
4 - photic stimulation
5 - medication withdrawal

A

3 - alcohol consumption
- can increase risk of seizures, but not used clinically

71
Q

Interictal epileptiform discharges (IEDs), meaning uncommon spikes, polyspikes, sharp waves, or spike and slow-wave complexes in between seizures are commonly observed in children with epilepsy. However, they can also be detected in 0.5% of adults and 2-6% of children who are healthy. Is this important?

A
  • Yes
  • important to ensure diagnosis is correct
72
Q

Patients can have multiple seizures within a 24 hour window, but this does not increase the risk of re-occurrence of seizures. What does increase the risk of re-occurrence in unprovoked (unknown cause) seizures?

1 - when seizure re-occurrence occurs in first 6 months
2 - when seizure re-occurrence occurs in first year
3 - when seizure re-occurrence occurs in first 2 years
4 - when seizure re-occurrence occurs in first 5 years

A

3 - when seizure re-occurrence occurs in first 2 years

  • 21-45% occur within first 2 years
  • higher if there are epileptiform discharges on EEG
73
Q

When a patient has a seizure, what should patients be told about their lifestyle changes in an attempt to reduce seizures occurring again?

1 - take medication regularly
2 - lose weight, avoid lack of sleep, reduce alcohol
3 - avoid lack of sleep, reduce alcohol and reduce risk of infections
4 - gain weight, avoid lack of sleep, reduce alcohol

A

3 - avoid lack of sleep, reduce alcohol and reduce risk of infections

74
Q

Why is it important to ensure patients at risk of seizures do not do the following:

  • unsupervised activities
  • bathing, swimming, working at heights, operating heavy machinery
  • driving
A
  • pose a risk to the individual and others
75
Q

Patients who have epilepsy are more susceptible to neuropsychiatric co-morbidities. Which of the following are they are increased risk of developing?

1 - depression
2 - anxiety
3 - suicide risk
4 - psychosis
5 - all of the above

A

5 - all of the above

76
Q

What does inter-ictally (latin for blow or stroke) mean in relation to epilepsy?

1 - occurring between seizures
2 - occurring before seizures
3 - occurring after seizures

A

1 - occurring between seizures

77
Q

In patients post-ictally, following a seizure, they typically experience all of the following EXCEPT which one?

1 - headahces
2 - confusion
3 - weight loss
4 - myalgia
5 - temporary weakness

A

3 - weight loss

78
Q

What is sudden unexplained death of epilepsy (SUDEP)?

A
  • unexplained death in epilepsy, but is rare
  • 2-18% incidence (higher in children)
  • more severe epilepsy are a higher risk
79
Q

In a focal / partial complex or simple seizures (affecting part of the brain), which of the following medications is the 1st line?

1 - Diazepam
2 - Carbamazepine
3 - Clozapine
4 - Amitriptyline

A

2 - Carbamazepine
- anti-epiletptic medication

  • 2nd line from out medication list is sodium valprolate
80
Q

In all forms of generalised seizure (affecting both sides of the hemisphere), which of the following medications is the 1st line?

1 - Diazepam
2 - Carbamazepine
3 - Clozapine
4 - Sodium Valprolate

A

4 - Sodium Valprolate
- mood stabiliser medication

  • second line medication is Carbamazepine an anti-epiletptic medication
81
Q

Which of the 3 core drugs Diazepam, Carbamazepine and Phenytoin have been shown to have adverse events in asian populations?

1 - Diazepam
2 - Carbamazepine
3 - Phenytoin

A

2 - carbamazepine
- asians (Chinese) are higher risk due to genetic risk

82
Q

Is epilepsy permanent?

A
  • no
  • patients can be remission
  • normally if a patient does not have a seizure within 1 year
83
Q

Patients can slowly be titrated off their epileptic medication if they are seizure free for how long?

1 - >6 months
2 - >1 year
3 - >2 years
4 - >4 years

A

3 - >2 years
- can also drive

84
Q

There are different things that can occur in seizures. Which of the following is the definition of Ictal?

1 - drowsy, confused, psychotic. Bitten tongue, lost continence
2 - feeling, sensations, changes in behaviour hours or days before the event
3 - actual event (may need witness description)
4 - immediately prior (not always present)

A

3 - actual event (may need witness description)

85
Q

When trying to image a patient with epilepsy, which 2 of the following contrasts are used?

1 - Tc-99m-ECD: Ethyl Cysteinate Dimer
2 - Tc-99m-HMPAO: Hexa methyl propyl amine oxime
3 - fluorine-18-fluorodeoxyglucose (F-FDG)

A

1 - Tc-99m-ECD: Ethyl Cysteinate Dimer
2 - Tc-99m-HMPAO: Hexa methyl propyl amine oxime

86
Q

Which of the following do seizures NOT typically occur in?

1 - intracerebral bleed
2 - herpes simplex encephalitis
3 - venous sinus thrombosis
4 - acute stroke

A

4 - acute stroke
- can occur, but it is rare

87
Q

What is the 1st line imaging in a seizure?

1 - CT
2 - MRI
3 - PET-CT
4 - ultrasound

A

1 - CT
- accessible, less contraindications and performed faster than MRI

Can also rule out other causes of seizures

MRI should be performed in <2 y/o with suspected epilepsy

88
Q

Which 2 of the following can be used to assess functional imaging in a child who is suspected of having epilepsy?

1 - PET
2 - SPECT / Ictal SPECT
3 - contrast CT
4 - X-ray

A

1 - PET
2 - SPECT / Ictal SPECT

PET = Positron emission tomography

SPECT = Single-photon emission computed tomography

Useful for identifying increased metabolic demand and identify specific regions of the brain, that may help if surgery is an option

89
Q

What is grey matter heterotopia?

1 - lack of grey matter
2 - grey matter being too small to function
3 - grey matter located in atypical locations
4 - all of the above

  • grey matter = neurons
  • white matter = communication pathways
A

3 - grey matter located in atypical locations

  • common in epilepsy
90
Q

What is grey matter schizencephaly, which is common in epilepsy?

1 - lack of grey matter
2 - grey matter being too small to function
3 - grey matter located in atypical locations
4 - abnormal clefts in the grey matter

  • grey matter = neurons
  • white matter = communication pathways
A

4 - abnormal clefts in the grey matter

91
Q

What is focal cortical dysplasia?

1 - neurons in an area of the brain failed to migrate in the proper formation in utero
2 - grey matter being too small to function
3 - grey matter located in atypical locations
4 - abnormal clefts in the grey matter

  • grey matter = neurons
  • white matter = communication pathways
A

1 - neurons in an area of the brain failed to migrate in the proper formation in utero
- common in epilepsy

92
Q

What is leukodystrophies?

1 - neurons in an area of the brain failed to migrate in the proper formation in utero
2 - abnormal degeneration of white matter in the brain
3 - grey matter located in atypical locations
4 - abnormal clefts in the grey matter

  • grey matter = neurons
  • white matter = communication pathways
A

2 - abnormal degeneration of white matter in the brain
- rare inherited disorder

93
Q

What is tuberose sclerosis?

1 - neurons in an area of the brain failed to migrate in the proper formation in utero
2 - abnormal degeneration of white matter in the brain
3 - grey matter located in atypical locations
4 - benign tumours that form in the brain

  • grey matter = neurons
  • white matter = communication pathways
A

4 - benign tumours that form in the brain
- can cause epileptic seizures

94
Q

In the image below, which of the following types of bleeds is this:

  • subdural = below dural matter and above the arachnoid membrane
  • epidural (also called extradural) = between skull and dura matter
  • subarachnoid = space surrounding the brain
A
  • subdural = below dural matter and above the arachnoid membrane
  • think concave/crescent shape
  • suB = Banana appearance
95
Q

In the image below, which of the following types of bleeds is this:

  • subdural = below dural matter and above the arachnoid membrane
  • epidural (also called extradural) = between skull and dura matter
  • subarachnoid = space surrounding the brain
A
  • epidural (also called extradural) = between skull and dura matter
  • think convex/lens shaped
  • Epi Pie = Epidural
96
Q

In the image below, which of the following types of bleeds is this:

  • subdural = below dural matter and above the arachnoid membrane
  • epidural (also called extradural) = between skull and dura matter
  • subarachnoid = space surrounding the brain
A
  • subarachnoid = space surrounding the brain
  • blood appears darker than the grey matter
  • these bleeds are able to bleed into the sulcus

A. Block D Neurology (39 decks)

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