Epilepsy

Question 1

What is the 4th mot common neurological disorder affecting people of all ages?

Answer 1

Epilepsy

Question 2

How many people will develop epilepsy?

Answer 2

1 and 26

Question 3

T/F Epilepsy is reversible?

Answer 3

True

Question 4

ILAE requirement for epilepsy?

Answer 4

at least two UNPROVOKED seizures

Question 5

What happens during a seizure?

Answer 5

too many nerve cells fire too quickly causing an electrical storm

Question 6

How many ppl live with uncontrolled epilepsy?

Answer 6

1.1 Million

Question 7

Who is more likely to have uncontrolled epilepsy?

Answer 7

Whites> African Americns

Question 8

ILAE Etiology for epilepsy?

Answer 8

Unknown 70%
genetics (w/ kids)
structural/ metabolic

Question 9

What is the #1 reason for status epilepsy?

Answer 9

Missed Medications

Question 10

Which 2 stages is not visible?

Answer 10

Prodrome

Aura

Question 11

What are the stages of seizure?

Answer 11

Prodrome
Aura
Seizure (Ictal)(Inter-lctal)
Post-ictal

Question 12

What stage has a warning sign before the seizure?

Answer 12

Prodrome

Question 13

What is the initial part of the seizure?

Answer 13

Aura

Question 14

Stage where the seizure goes and comes again?

Answer 14

Inter-ictal

Question 15

What are the new classification of seizures by ILAE?

Answer 15

Focal
Generalized
Unknown

Question 16

What is the most common type of seizure?

Answer 16

Focal (60%)

Question 17

Repeated, purposeless, movements

Answer 17

Automatisms

Question 18

Atonic

Answer 18

“drop seizures”

Question 19

Most common cause of focal seizures?

Answer 19

Temporal Lobe Seizures

Question 20

Jamais vu?

Answer 20

really have done it, but think you never done it before

Question 21

Seizure common in kids?

Answer 21

Typical Absence (Petit mal)

Question 22

EEG finding 3-Hz spike and wave

Answer 22

Typical Absence (Petit mal)

Question 23

Treatment of Petit mal?

Answer 23

Ethosuximide (Zarontin)

Question 24

Atypical Absence seizure

Answer 24

longer typical absence

Question 25

Brief shock like jerks

Answer 25

Myoclonic seizure

Question 26

Usually occurs during sleep, tighten up

Answer 26

Tonic seizures

Question 27

Rapid stiffing and convuslsions

Answer 27

Clonic seizures

Question 28

Drop attacks

Answer 28

Atonic seizures

Question 29

Cries, groaning, injuries from fall

Answer 29

Grand mal (Tonic-clonic)

Question 30

How many people really have epilepsy?

Answer 30

1 out of 6

Question 31

Clinically resembles seizures, but extremely prolonged

Answer 31

Psychogenic non-epileptic seizure/spells (PNES)

Question 32

Txt for PNES?

Answer 32

Cognitive Behavioral Therapy (CBT) | Continue to adjust, or discontinue AEDs b/c mood stabilizers

Question 33

What percent of PNES resolve once given diagnosis?

Answer 33

50%

Question 34

1st step in diagnosis of Epilepsy?

Answer 34

Hx, witness, video, PmHx

Question 35

Epilepsy physical exam

Answer 35

normal physical exam during seizures

Question 36

Epilepsy labs

Answer 36

CBC, CMP, TSH, EKG, LP, HIV and Syphilis, Magnesium

Question 37

Helps classify the seizure for proper treatment, guide for prognosis

Answer 37

EEG

Question 38

What is the DOC of choice for epilepsy?

Answer 38

MRI

Question 39

What is the initial test for epilepsy?

Answer 39

Head CT

Question 40

What is the gold standard for diagnosing seizures and spells?

Answer 40

Video EEG Monitoring VEEGM

Question 41

The best diagnosis for epilepsy?

Answer 41

Hospitalization VEEGM

Question 42

TXT of epilepsy should occur when?

Answer 42

after two or more unprovoked seizures

Question 43

1st line TXT for epilepsy?

Answer 43

Anti-Epileptic drugs (AEDs)

Question 44

When should you stop increasing dose?

Answer 44

once seizures are controlled or develop side effects

Question 45

How should AEDs be administrated?

Answer 45

start low and go slow

Question 46

What is the most common cause of drug failure?

Answer 46

WRONG diagnosis

Question 47

When is epilepsy considered "medically refractory"

Answer 47

if fail 2 correct drugs

Question 48

1st line txt for focal seizures?

Answer 48

Carbamazepine (Tegretol), Lamotrigine (Lamictal)

Question 49

1ST line txt for generalized seizures?

Answer 49

Valproate (Depakene)

Question 50

1st line txt for absence seizures?

Answer 50

Ethosuximide (Zarontin), Sodium valproate (Depakene)

Question 51

Med to avoid in pregnancy?

Answer 51

Valproate

Question 52

Dx for pregnancy?

Answer 52

Lamotrigine, Levetiracetam (Keppra), or Oxcarbazepine (Trileptal)

Question 53

T/F all AEDs are teratogenic, but seizures also toxic to fetus?

Answer 53

TRUE

Question 54

Most common cause of low drug levels and Status Epilepticus?

Answer 54

Non-compliance

Question 55

What should be obtained when control is achieved or max out drug?

Answer 55

steady-state trough level

Question 56

When is discontinuation of meds if seizure free?

Answer 56

pt has a normal EEG and MRI adults- 2yrs children- 2-5yrs

Question 57

When not controlled w/ meds what is the next avenue?

Answer 57

brain surgery

Question 58

Other treatment option for epilepsy?

Answer 58

Vagal Nerve Stimulation (VNS)

Question 59

What is the 'pacemaker of the brain"

Answer 59

Vagal nerve

Question 60

What is the most common cause of Status Epilepticus?

Answer 60

non-compliance w/ AEDs

Question 61

Medical Emergency?

Answer 61

Convulsive and non-convulsive status epilepticus

Question 62

Txt for Status Epilepticus?

Answer 62

- Maintain Airway - IV lorazepam 4mg - Admit to ICU - IV Fosphenytoin (Cerebyx) - Phenytoin (Dilantin)

Question 63

Which diet works best in children?

Answer 63

Ketogenic Diet

Question 64

Txt for non-convulsive

Answer 64

txt same

Question 65

What causes Sudden Unexpected Death in Epilepsy (SUDEP)

Answer 65

UNKNOWN | generalized tonic-clonic seizures

Question 66

Txt for SUDEP

Answer 66

ER meds Turn pt on recovery side Suction mouth and provide oxygen

Question 67

Txt for Alcohol withdrawal seizures

Answer 67

acutely w/ benzo (diazepam/ lorazepam)

Question 68

3 reasons to admit pts?

Answer 68

Status epilepticus Seizure characterization Surgical evaluation

Question 69

Top 3 triggers of seizures

Answer 69

Missed meds lack of sleep, fatigue Photosensitivity

Question 70

What are the 3 types of focal seizures?

Answer 70

aware unaware unconscious

Question 71

What are the 6 types of generalized seizures?

Answer 71

``` absence atypical absence myoclonic tonic clonic GTCS atonic ```

Question 72

if two meds don't work...

Answer 72

move to VNS

Question 73

if VNS don't work...

Answer 73

move to surgery

Question 74

What are the ddx for focal seizures?

Answer 74

- TIA - Migraine aura - Rage attacks - Panic attacks

Question 75

What are the ddx for generalized seizures?

Answer 75

- Syncope - Cardiac disease - Brainstem ischemia (CVA) - Psychogenic nonepileptic seizures (PNES)

Question 76

What is the purpose for the txt of epilepsy?

Answer 76

prevent/ reduce seizure activity, severity, mortality, and complications

Question 77

When should labs be checked?

Answer 77

- Recheck pregnant - Breakthrough seizures - Change in dosing - Adding another drug