Seizure

Question 1

Seizure foci in the temporal lobes commonly produce these sensations

Answer 1

Nausea and epigastric discomfort, fear, olfactory symptoms, auditory hallucinations, deja vu, jamais vu

Question 2

What is a focal (formerly partial) seizure?

Answer 2

The first clinical and/or EEG manifestations localize to one part of one cerebral hemisphere

Question 3

What is a generalized seizure?

Answer 3

The first clinical and/or EEG manifestations involve both hemispheres

Question 4

Appearance of infantile spasms?

Answer 4

Sudden, rapid flexion of neck and trunk, adduction of shoulders, variable flexion of lower extremities

Question 5

Appearance of myoclonic seizures?

Answer 5

Nonryhthmic, rapid, jerking movements that can be local or widespread

Question 6

Common triggers of seizure

Answer 6

Hypoxia, hyponatremia, hypoglycemia, hyperglycemia, hypocalcemia, hypomagnesemia, uremia, hepatic failure, fever, drugs

Question 7

Epidemiology and natural history of childhood absence epilepsy

Answer 7

Absence seizures beginning age 4-8y, and usually resolve before adulthood

Question 8

Features and natural history of juvenile myoclonic epilepsy

Answer 8

Myoclonic jerks, generalized tonic-clonic seizures in 90% of pts, absence seizures in 25%, usually in children 12-18yo, usually requires lifelong medication

Question 9

Features of benign childhood epilepsy with centrotemporal spikes (benign rolandic epilepsy)

Answer 9

Pts have simple partial seizures with abnormal movements and abnl oral sensations, with salivation and drooling. Pts do not lose consciousness. +/- secondary generalization

Age usually 5-10y, almost always resolve by age 18

Question 10

Features of Lennox-Gastaut syndrome

Answer 10

• Triad of: mental retardation, diffuse slow spike-and-wave pattern on EEG, and multiple types of generalized seizures.
• Usually age 2-8yo.
• Caused by underlying brain abnormalities (various kinds)

Question 11

Most common site of localization-related epilepsy syndromes

Answer 11

Temporal lobe

Mesial temporal sclerosis = common cause in younger pts

Question 12

AED therapy for focal seizures (+/- secondary generalization)

Answer 12

Respond equally well to almost any AED:
Carbamazepine
Phenytoin
Oxcarbazepine
Topiramate
Valproic acid (less well tolerated)
Lamotrigine if pts have previously been on another AED
NO ethosuximide

Question 13

AED therapy for absence seizures

Answer 13

Ethosuximide and valproic acid
Valproic acid if any other seizure types besides absence
Lamotrigine

Question 14

AED therapy for myoclonic seizures

Answer 14

Valproic acid = drug of choice

Levetiracetam

Question 15

AED therapy for generalized tonic-clonic seizures

Answer 15

Phenytoin, valproic acid, lamotrigine, levetiracetam, and topiramate are reasonable. Phenytoin and topiramate FDA approved for this type of epilepsy

Question 16

AED therapy for infantile spasms

Answer 16

Vigabatrin (requires regular visual testing for visual field constriction)
Corticotropin (ACTH)

Question 17

General principles for starting AED therapy

Answer 17

• Begin at low dose and increase slowly
• Use one drug at a time, adding if not controlled at highest dose of current med
• Monitor bone density for patients on phenytoin, valproic acid, phenobarbitol, or primidone
• Need to monitor blood levels for many AEDs

Question 18

When is surgery considered for epilepsy?

Answer 18

When pt has failed at least 3 AEDs and they have a definite single seizure focus that is amenable to surgical resection