Seizures, Epilepsy and Sleep disorders

Question 1

What is a seizure?

Answer 1

TEMPORARY alteration in
BRAIN FUNCTION due to
EXCESSIVE AND SYNCHRONIZED
neuronal activity

Question 2

What is epilepsy?

Answer 2

GROUP of d/o
with a TENDENCY TOWARDS
RECURRENT AND UNPROVOKED SEIZURES
typically dx after TWO
UNPROVOKED sz

Question 3

What idiopathic/genetic epilepsy is characterzied by centrotemporal spikes on EEG and nocturnal sz with salivation? Patients usually outgrow this.

Answer 3

Rolandic epilepsy. Peak at age 5-8

Question 4

What is the treatment for Rasmussen’s encephalitis?

Answer 4

Hemispherectomy

IVIG

Question 5

When is corpus callotomy indicated? How about Vagus nerve stimulator?

Answer 5

Drop attacks

Medically intractable epilepsy

Question 6

What NSS intervention may be done for mesial temporal seizures?

Answer 6

Focal resection

Question 7

What is the treatment for fifth day fits or benign neonatal convulsions?

Answer 7

Treat with phenobarbital

Question 8

What is the treatment of choice for childhood absence epilepsy?

Answer 8

Ethosuximide

Question 9

What is the treatment of choice for Juvenile myoclonic epilepsy?

Answer 9

Valproic acid in boys

Lamotrigine in girls (LG ref brand)

Question 10

What do you call infantile spasms with mental retardation?

Answer 10

West syndrome

Question 11

What is the treatment for infantile spasms?

Answer 11

ACTH

Question 12

What is the EEG finding for infantile spasms VS Lennox gestaut?

Answer 12

IS: Hypsarrhythmia, high amplitude sharpa and slow waves
LG: Spike and wave discharge of 1.5-2 Hz MORE ABNORMAL IN SLEEP

Question 13

Compare the prognosis of lafora dz and baltic myoclonus

Answer 13

LD: Chromosome 6 RAPID progression quadriparesis, dementia and death
BM: Chromosome 21 Ataxia and dementia occur late and usually are mild

Question 14

What is the epilepsy syndrome that involves the progressive aphasia in healthy children with the appearance of paroxysmal EEG changes usually in sleep?

Answer 14

Landau-Kleffner syndrome

Question 15

What common electrolyte abnormality DOES NOT CAUSE sz?

Answer 15

Potassium

Question 16

When is a febrile seizure considered complex?

Answer 16

More than 15 minutes

Question 17

What is the management for alcohol withdrawal?

Answer 17

In order: 
1. Thiamine
2. Glucose
3. Correct fluid and electrolyte abnormalities
4. Magnesium
5. Lorazepam
NO ROLE FOR PHENYTOIN

Question 18

What should metabolic panel workup target in patients with seizures?

Answer 18

Sodium
Glucose
Thyroid function tests
Calcium
Magnesium
Renal failure

Question 19

What can be done to increase yield of EEG findings?

Answer 19

Sleep deprivation
Photic stimulation
Hyperventilation

Question 20

What is the most common PSYCHIATRIC diagnosis in patients with epilepsy?

Answer 20

Depression

Question 21

Almost all anti-sz meds are hepatically metabolized EXCEPT FOR which 3?

Answer 21

Gabapentin
Lamotrigine
Vigabatrin
GABi Vanquished Liver

Question 22

What AE drugs act on:
1 Sodium channel
2 GABA
3 Calcium channel
4. NMDA

Answer 22

Na: Carbamazepine, Lamotrigine, Phenytoin
GABA: Tiagabine, Vigabatrin, Barbiturates, Benzos
Ca: Gabapentin, Valproic acid, Ethosuximide
NMDA: Felbamate, Topiramate, Phenobarbital

Question 23

What are the MOA of valproic acid?

Answer 23

Val wears CK and GABA NA

Question 24

What are the MOA of phenobarbital and topiramate?

Answer 24

TOP BARBIE wears NMDA and GABANA

Question 25

What is the DOC for myoclonic seizures?

Answer 25

Valproic acid

Question 26

What are the AE of phenytoin?

Answer 26

Gingival hyperlasia Hirsutism Peripheral neuropathy Osteoperosis

Question 27

``` What AED has Adverse effects: Weight gain Hair loss Hepatotoxicity like HOMER SIMPSON! ```

Answer 27

Valproic acid

Question 28

What AEDs cause weight loss?

Answer 28

Topiramate and Zonisamide

Question 29

What causes life threatening hepatotoxicity?

Answer 29

Valproic acid

Question 30

What are the teratogenic effects of Valproic acid Carbamazepine Phenytoin

Answer 30

Valproic acid: Spina bifida Carbamazepine: Spina bifida with craniofacial Phenytoin: Hydantoin syndrome: IUGR, microcephaly, craniofacial, extermity defects

Question 31

What is folate supplementation for epileptic women of childbearing age?

Answer 31

4mg/day

Question 32

What happens to AED requirement during pregnancy?

Answer 32

Usually increases

Question 33

What is the order of management of status epilepticus?

Answer 33

``` Airway Breathing Circulation Thiamine 100mg IV Glucose 50ml of 50% dextrose Lorazepam 2mg IV Repeat every minute up to 0.1mg/kg IF NO RESPONSE TRY THE FF: 1. Phenytoin 20mg/kg IV 2. Phenobarbital 15mg/kg IV 3. Valproate 20mg/kg IV IF NO RESPONSE TRY THE FF: 1. Propofol 2. Pentobarbital 3. Midazolam ```

Question 34

What is normal EEG during: 1. Sleep 2. Drowsiness 3. Awake

Answer 34

1. Sleep: Delta <4 2. Drowsy theta 4-7 3. Alpha with eyes closed and beta with eyes open

Question 35

What are the physical findings during REM sleep?

Answer 35

Rapid pulse/ Respiratory rate Erection Mental activity increased/ Muscle paralysis REM!

Question 36

Are wicket waves on EEG suggestive of epileptiform discharges?

Answer 36

NO! They are benign! In older adults during light sleep occurring in the temporal region.

Question 37

What is EEG for hepatic encephalopathy?

Answer 37

Triphasic waves

Question 38

What is EEG for epeleptiform discharge?

Answer 38

Spike <70msec | Sharp wave 70-200msec

Question 39

What is EEG for brain lesion?

Answer 39

Focal slowing

Question 40

What is EEG for Anoxia?

Answer 40

Burst suppression: sharp waves interrupted by delta wave or no activity

Question 41

What is the minimum duration required for a respiratory event to be called obstructive apnea or hypopnea?

Answer 41

10 seconds

Question 42

What triggers cataplexy in narcoleptics?

Answer 42

Strong emotion or exercise

Question 43

How to differentiate nightmare from sleep terror?

Answer 43

N: Less intense vocalization, Second half of night, Less than 30 minutes, Recall present, REM on EEG

Question 44

What is treatment for Sleepwalking?

Answer 44

Benzodiazepenes

Question 45

What is significant in narcolepsy with cataplexy CSF patient?

Answer 45

Hypocretin level of less than 110

Question 46

What is treatment for resless legs syndrome?

Answer 46

Dopamine agonists, levodopa, opiods, gabapentin, benzos