Seizures

Question 1

What percentage of the population will have a seizures during their lifetime?

Answer 1

10%

Question 2

What is the definition of a simple partial seizure?

Answer 2

a seizure that begins in a focal area of the brain and does not impair awareness.

Question 3

What is the definition of a complex partial seizure/

Answer 3

a seizure with a focal onset that causes an impairment in awareness

Question 4

Where is the most common location of onset for a complex partial seizure?

Answer 4

temporal lobe

Question 5

What are some typical signs of a complex partial seizure?

Answer 5

lip smacking, chewing movements, picking at clothes, etc.

Question 6

How do generalized tonic-clonic seizures typically start?

Answer 6

with a tonic phase that lasts several seconds in which the entire body becomes stiff, followed by a clonic phase

Question 7

True or false: the rhythmic jerking of the clonic phase tends to occur asymmetrically in the body.

Answer 7

false - symmetric

Question 8

What is the classic EEG finding in absence seizures?

Answer 8

three-per-second generalized spike-and-wave pattern

Question 9

Is an absence seizure focal or generalized?

Answer 9

generalized

Question 10

What is the most common cause of seizures in children?

Answer 10

febrile

Question 11

What is the most common cause of seizures in the elderly?

Answer 11

stroke

Question 12

What genetic cause of seizures will present in childhood with essentially any seizure type, intellectual disability and an EEG with slow (1 to 2/second) spike and wave discharges?

Answer 12

Lennox-Gastaut syndrome

Question 13

What genetic epilepsy syndrome will present in childhood with simple partial seizures that have a nocturnal preponderance with centrotemporal spikes on an EEG?

Answer 13

benign rolandic epilepsy

Question 14

What genetic epilepsy syndrome will present in adolescence or young adulthood with myoclonic, absence, or generalized tonic-clonic seizures occurring mainly in the early morning with a 4 to 6/per second polyspike and wave pattern on EEG?

Answer 14

Juvenile myoclonic epilepsy

Question 15

Todd’s paralysis will typically be seen after what type of seizure?

Answer 15

after a secondarily generalized seizure

Question 16

What lab abnormality will typically be seen after a tonic clonic seizure?

Answer 16

lactic acidosis with low bicarb

Question 17

What is the preferred imaging modality in a patient with a first-time seizure?

Answer 17

MRI

Question 18

What percentage of patients with epilepsy will have their seizures well controlled on monotherapy?

Answer 18

70%

Question 19

For phenytoin: site of action, seizure type treated, and main side effects?

Answer 19

Na+ channel

partial

gingival hyperplasia, coarsening of facial features, ataxia

Question 20

For carbamazepine: site of action, seizure type treated, and main side effects?

Answer 20

Na+ channel

partial

hyponatremia, agranulocytosis, diplopia

Question 21

For valproic acid: site of action, seizure type treated, and main side effects?

Answer 21

Na+ channels, GABA receptor

partial, generalized

GI symptoms, tremor, weight gain, hair loss, hepatotoxicity, thrombocytopenia

Question 22

For phenobarbital: site of action, seizure type treated, and main side effects?

Answer 22

GABA receptor

partial, generalized

sedation

Question 23

Ethosuximide: site of action, seizure type treated, and main side effects?

Answer 23

T-type Ca2+ channel

Absence

GI symptoms

Question 24

Gabapentin: site of action, seizure type treated, and main side effects?

Answer 24

unknown, but possibly a voltage-gated Ca2+ channel

partial

sedation, ataxia

Question 25

Lamotrigine: site of action, seizure type treated, and main side effects?

Answer 25

NA+ channel, glutamate receptor partial, generalized Rash, Stevens-Johnson syndrome

Question 26

Topiramate: site of action, seizure type treated, and main side effects?

Answer 26

NA+ channel, GABA activity partial, generalized word-finding difficulty, renal stones, weight loss, tingling in hands and feet

Question 27

Tiagabine: site of action, seizure type treated, and main side effects?

Answer 27

GABA reuptake partial sedation

Question 28

Levetiracetam: site of action, seizure type treated, and main side effects?

Answer 28

unknown, but possibly at synaptic vesicles partial, generalized insomnia, anxiety, irritability

Question 29

Oxcarbazepine: site of action, seizure type treated, and main side effects?

Answer 29

Na+ channel partial sedation, hyponatremia

Question 30

Zonisamide: site of action, seizure type treated, and main side effects?

Answer 30

unknown mech of action partial, generalized sedation, renal stones, weight loss

Question 31

What are the management steps for status epilepticus?

Answer 31

1. ABCs, check glucose, establish IV access 2. 100 mg IV thiamine followed by D50 influsion 3. Lorazepam 0.1 mg/kg IV 4. Phenytoin 20 mk/kg IV (or fosphenytoin) 5. intubate if not already done 6. phenobarbital 20 mg/kg IV 7. induce coma with barbiturates, midazolam or propofol and institute continuous beside EEG monitoring

Question 32

Which AED is particularly concerning for birth defects?

Answer 32

valproic acid (neural tube defects)