Seizure

Question 1

Epilepsy definition

Answer 1

> 2 unprovoked SZ, 24 hours apart

OR

1 unprovoked SZ c 60% chances of recurrence in 10 years

Question 2

True SZ vs Psycho SZ

Answer 2

Sr. PRL increases for 30 min in TSZ

Question 3

Focal Seizure/ Partial seizure Etiology

Answer 3

Discrete lesion

Structural Abnormality in the brain
Abscess/Tumour

Question 4

Generalized Seizure Etiology

Answer 4

Diffuse lesion

Drugs / Metabolic (glu, Na+) / Toxins

Question 5

Drugs causing Epilepsy

5AF

Answer 5

ABX (FQ/ B-L)

ANTI MALARIALS (CQ/MFQ)

ANTI VIRALS (ACY/GANCI)

ANTI CANCER (Busalfan/ chlorambucil)

ANESTHETICS (Fentanyl/ Meperidine/ Tramadol)

FLUMAZENIL

Question 6

Toxins causing SZ

Answer 6

Withdrawal: Alcohol / Baclofen / Zolpidem / Barbiturate

OD: Cocaine/ Amphetamine

Question 7

Focal Sz features

Answer 7

Automatism +

AURA+

Anterograde amnesia +

DURATION > 1min

Post ictal confusion +

LOC +/-

Loss of cognition +/-

+ve in CPS. -ve in SPS
(DYSCOGNITIVE)

Question 8

C/f focal SZ

Answer 8

Todds paresis (Post Ictal Paralysis—self recoverable)

Jacksonian march (DIST—> PROX in 1 limb ONLY)

Question 9

Absence sz features

Answer 9

Same as CPS BUT

<30 s
NO post ictal confusion
Tone = normal
100-140/day
4-8 years of age
AURA -

Remission by PUBERTY
F/h/o 20-40%

Question 10

EEG Absence Sz

Answer 10

Spike and dome pattern (2-4Hz)

Precipitated by HYPERVENTILATION AND PHOTIC STIMULATION

Question 11

Atypical Absence SZ features

Answer 11

Less abrupt

Increased DURATION

EEG-
Spike and wave <2.5 Hz**

Structural abnormalities ++

Resistant to AED

Question 12

Myoclonic sz features

Answer 12

Jerky epilepsy

Caused dt Hypoxia/ Degenerative / Metabolic

Hanging—-> myoclonic sz

Question 13

JME features

Answer 13

Early morning b/l jerks

Early adolescence

F/h/o +ve

Ppt by— FATIGUE/ Alcohol / SLEEP deprv

LOC x

AUTOMATISM x

Spike and wave pattern +

Neuroimaging NORMAL

Cx—GTCS

Remission uncommon

Question 14

Stages of GTCS

Answer 14

Premonitary symptoms - Nausea/Abdo pain/ foaming saliva**/ palpitation

Tonic phase- (10-20/s)

1) Decorticate rigditiy
2) Versive head extension
3) Ictal cry + cyanosis

Clonic phase- (jerky) <1’min

Post Ictal phase-
Floppy
U. Incontinence
CONFUSION+

Question 15

Aura types and lobes

Only in focal sz

Answer 15

Olfactory-temporal
Auditory- Lateral temporal
Gustatory- Parietal
Visual- occipital

Question 16

Neuroimaging in GTCS

Answer 16

Maybe +

Question 17

Epileptogenic potential of 3 types of stroke in order

Answer 17

Embolic»Hemorrhagic»thrombotic

Question 18

Which type of SZ in Degenerative brain d/o

Answer 18

Myoclonic SZ

Question 19

When to GIVE AED

Answer 19

F/H/O
Abnormal neuro exam (todds)
Abnormal imaging
Stat ep

Question 20

Stokes adams attack

Answer 20

Decreased Bp with decreased HR
(Dt myocardial muscle hypoxia)

SZ= Myoclonic

S/I elderly

Question 21

When not to stop AED

Answer 21

F/h/o
Abnormal eeg
Abnormal neuro exam
Sz free for 2-5 years

Question 22

SJS which AED

Answer 22

Lamotrigine

<1%

Question 23

Aplastic anemia S/E AED

Answer 23

CBZ

Question 24

Phenytoin S/E

6H OM

Answer 24

Hirsutism

Hydatoin syndrome (microcep/cleft/limb hypoplasia)

Hyperglycaemia

Hepatitis

Hypersensitivity

Hyperplasia of Gums

Megaloblastic anemia

Osteomalacia

Question 25

Hyponatremia s/I which AED

Answer 25

OXC & CBZ

Question 26

Na entry inhibitors AED

Answer 26

Lamotrigine | CBZ

Question 27

Phenytoin MOA

Answer 27

Na and Ca inhibitor

Question 28

Pseudolymphoma s/i which drugs | Lymphadenopathy ++

Answer 28

PHENYTOIN PRIMIDONE

Question 29

Which AED exclusively excreted through kidneys

Answer 29

LEVETIRACETAM

Question 30

GTCS drugs | VLT

Answer 30

Val (x T type Ca+ channels in thalamus**) Lamo Topi

Question 31

Which is the only drug not causing obesity AED

Answer 31

Topiramate | xNa+

Question 32

NTD in which AED

Answer 32

CBZ PHENYTOIN VALPROATE Rx- FA 3 months before pregancy Vit K in last 2 weeks of pregnancy to mother if PHENYTOIN+

Question 33

Absence SZ drugs | EVL

Answer 33

Ethosuximide (T type Ca ch in Thalamus) Val Lamo

Question 34

Doc atypical absence SZ

Answer 34

Valproate

Question 35

Pregnancy safe drugs | LOL

Answer 35

Lamo Oxc Levi

Question 36

Breast milk excretion max and min

Answer 36

Max levi | Min val

Question 37

Estrogen vs progesterone epileptogenic

Answer 37

Yes. No.

Question 38

JME drugs | VLL

Answer 38

Valproate (broad spectrum—will prebent progress to all three sz) Lamo Levi

Question 39

C/I drugs in JME

Answer 39

Phenytoin CBZ (Increase myoclonus)

Question 40

JME DOC in preganancy

Answer 40

LEVETIRACETAM | Lamo= risk of myoclonus

Question 41

S/E valproate | HAWA GIT

Answer 41

``` Hepatotoxic Ataxia/tremors/sedation Weight gain Ammonia increase GIT irritation ITP Transient alopecia/ TERATOGENIC ```

Question 42

EPILEPSIA PARTIALIS CONTINUA

Answer 42

Stat ep with FOCAL SZ | Can be caused dt hypo/hyperglycemia as well

Question 43

Rx stat ep

Answer 43

Loraz/Midaz—Fosphenytoin>>Slow infusion phenytoin >> val >> levi——propfol (early ref SZ)—-iv thiopentone(late ref sz)

Question 44

AED not recommended in STAT EP

Answer 44

CBZ | As only in oral form

Question 45

Syncope vs Seizure

Answer 45

Tongue bite- Tip. Lateral edge Position- standing. Supine/standing