Epilepsy

Question 1

Answer 1

Question 2

Name the epilepsy syndrome

Answer 2

Question 3

Name Side Effects of Each:

1. Carbamazepine
2. Carbamazepine and Oxcarbazepine
3. Valproic acid
4. Topiramate and Zonisamide:

Answer 3

1.Interactions with other hepatically metabolized drugs and increased risk for osteoporosis and hypercholesterolemia

2. Hyponatremia, pancytopenia
3. Weight gain, hypercholesterolemia, PCOS, teratogenicity, hepatotoxicity, increase ammonia levels
4. Increased risk of kidney stones💎

all AEDs: drug hypersensitivity syndrome, SJS, and suicidal ideation

Question 4

What is the diagnostic definition of epilepsy?

Answer 4

Two or more unprovoked seizures >24 hours apart, or one unprovoked seizure with high risk for recurrence.

Question 5

What defines a focal seizure?

Answer 5

Electrical discharge originating from a specific region of the brain.

Question 6

What are the two types of focal seizures based on awareness?

Answer 6

Focal Seizures with awareness

Focal seizures without awareness

Question 7

How might a focal seizure present clinically?

Answer 7

As a “staring episode.”

Question 8

What is a secondary generalized seizure?

Answer 8

A focal seizure that spreads to involve the entire cerebral cortex.

Question 9

How do primary generalized seizures differ from secondary generalized seizures?

Answer 9

Primary generalized seizures start with a diffuse discharge involving the whole brain simultaneously, while secondary generalized seizures begin focally and then generalize.

Question 10

What are common comorbidities of epilepsy?

Answer 10

Mood disorders, sleep disorders, metabolic bone disease, and hyperlipidemia.

Question 11

What are common causes of provoked seizures?

Answer 11

Metabolic disturbances, drug intoxication or withdrawal, infection.

Question 12

How are single provoked seizures managed?

Answer 12

Correct the underlying cause

Anti-Elliptic Usually not needed

Question 13

When is diagnostic evaluation not needed after a provoked seizure?

Answer 13

If the patient has a normal neurologic examination.

Question 14

What are characteristic features of psychogenic nonepileptic spells (PNES)?

Answer 14

Forced eye closure, long duration, hypermotor activity that starts and stops, asynchronous, asymmetric flailing of extremities.

Question 15

How is PNES diagnosed?

Answer 15

Inpatient video EEG monitoring.

Question 16

What is PNES strongly associated with in military veterans?

Answer 16

PTSD.

Question 17

What is included in the initial evaluation for a first unprovoked seizure?

Answer 17

EEG (normal EEG does not rule out seizure), CBC, electrolyte and glucose levels, toxicology screen, brain MRI (or CT head in emergencies), CSF analysis if fever, prolonged altered mental status, immunosuppression, or severe headache.

Question 18

What should you do if a patient does not return to baseline mental status 15 minutes after a seizure?

Answer 18

Obtain continuous EEG to rule out nonconvulsive status epilepticus.

Question 19

How can you differentiate syncope from seizure?

Answer 19

Syncope involves brief loss of consciousness, occasional tonic-clonic jerking, but quick and complete recovery.

Question 20

Should you diagnose absence seizures in adults?

Answer 20

No, absence seizures are not typically diagnosed in adults.

Question 21

When should anticonvulsant therapy be started after seizures?

Answer 21

After ≥2 unprovoked seizures or after a single high-risk unprovoked seizure (with focal findings on neuroimaging, EEG, or severe head trauma).

Question 22

What can adding new medications that alter AED metabolism result in?

Answer 22

Loss of seizure control.

Question 23

When should epilepsy surgery be considered?

Answer 23

When patients fail to respond to their first and second AEDs (in sequence or combination).

Question 24

What is the most common epilepsy surgery?

Answer 24

Mesial Temporal Lobe Resection

Remove - sclerotic lesions associated with focal seizures

Question 25

When should emergent head imaging be obtained in status epilepticus?

Answer 25

If the cause is unknown; however, imaging should not delay treatment.

Question 26

What is the most common cause of convulsive status epilepticus?

Answer 26

Low antiepileptic drug (AED) blood level.

Question 27

Which IV anti-epileptic drug is preferred for Anti-epileptic Naive patients?

Answer 27

Fosphenytoin (preferred over phenytoin).

Question 28

What should be done if a patient stops seizing but does not return to baseline within 30 minutes?

Answer 28

Start continuous EEG monitoring to check for nonconvulsive seizures.

Question 29

Should AEDs be given for primary prophylaxis after a new stroke or brain tumor?

Answer 29

No, primary AED prophylaxis is not indicated.

Question 30

What is required for patients with juvenile myoclonic epilepsy?

Answer 30

Lifelong Anti-Epileptic Medication

Question 31

Which AEDs Inactivate hormonal contraception?

Answer 31

1. Carbamazepine 2. Oxacarbazepine 3. Phenytoin 4. Topiramate

Question 32

A Generalized Tonic-Clonic Seizure lasting more than 5 minutes or 2 seizures within 5 minutes w/o return to baseline between seizures Management ?

Answer 32

Convulsive Status Epilepticus 1. Emergent CT Head -if no known underlying cause ——-Thiamine and Glucose- if ETOH use is suspected 2. First-line treatment is IV lorazepam, IV diazepam, or IM midazolam. ——-Benzodiazepines should be followed by an IV AED to avoid seizure recurrence. IV Keppra

Question 33

What is anticonvulsant hypersensitivity syndrome?

Answer 33

Rare disorder t develops within 2 months of starting AED ## Footnote This syndrome can lead to severe complications if not recognized and managed promptly.

Question 34

What are the clinical manifestations of anticonvulsant hypersensitivity syndrome?

Answer 34

* Fever * Rash * Pharyngitis * Lymphadenopathy * Facial swelling * Systemic organ involvement (such as hepatitis or nephritis) ## Footnote These symptoms can vary in severity and may affect multiple organ systems.

Question 35

What is the typical time frame for the development of anticonvulsant hypersensitivity syndrome after starting therapy?

Answer 35

Typically within two months. ## Footnote Early recognition is crucial for effective management.

Question 36

What is the management for anticonvulsant hypersensitivity syndrome?

Answer 36

* Discontinuing the offending drug * Administering systemic glucocorticoids ## Footnote Prompt intervention is essential to prevent further complications.