Adult and Pediatric Epilepsy Quiz
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Questions and Answers

Based on the patient's history and studies, what is the chance of seizure recurrence for this patient?

  • 3 years (correct)
  • 2 years (correct)
  • 5 years (correct)
  • 4 years (correct)

    • Which of the following statements is true regarding initiation of an AED for an unprovoked first seizure?

  • Antiepileptic drug therapy should be recommended in any patient with an unprovoked first seizure, regardless of normal or abnormal results of brain imaging or EEG (correct)
  • Immediate AED therapy as compared with the delay of treatment pending a second seizure is likely to improve quality of life (correct)
  • The potential AED adverse effects are generally severe and some may be irreversible (correct)
  • Over the longer term (>3 years), immediate AED therapy is likely to improve the prognosis for sustained seizure remission (correct)
  • Immediate AED therapy as compared with the delay of treatment pending a second seizure is likely to reduce seizure recurrence in the subsequent 2 years (correct)

    • Which of the following is correct regarding the EEG in Figure 5.7?

  • An eye closure is recorded during this EEG page (correct)
  • The patient is sleeping (correct)
  • There is poor reactivity of the posterior background (correct)
  • The patient has an occipital seizure (correct)
  • The posterior background shows δ-frequencies (correct)

    • Which of the following is correct regarding EEG frequencies?

    <p>γ-frequency is &gt;30 Hz</p> Signup and view all the answers

    If an antiepileptic drug (AED) is required in pregnancy, which of the following medications would be the best choice in terms of safety evidence?

    <p>Lamotrigine</p> Signup and view all the answers

    Which of the following AEDs is associated with weight loss?

    <p>Topiramate</p> Signup and view all the answers

    The clinical features of seizures in mesial temporal lobe epilepsy may have all of the following characteristic symptoms, except:

    <p>Tonic posturing of one limb (fencer’s posture)</p> Signup and view all the answers

    Which of the following AEDs would have the least drug–drug interactions?

    <p>Gabapentin</p> Signup and view all the answers

    In a young child with generalized epilepsy refractory to multiple antiepileptic medications, what would be the next best choice of treatment, if tolerated?

    <p>Ketogenic diet</p> Signup and view all the answers

    Which of the following is the best treatment option for simple febrile seizures (FSs)?

    <p>Supportive management</p> Signup and view all the answers

    Mutations in which of the following genes is most commonly associated with generalized epilepsy with febrile seizures plus (GEFS+)?

    <p>SCN1A</p> Signup and view all the answers

    A 13-year-old girl is being evaluated for epilepsia partialis continua. Rasmussen’s syndrome is suspected. What would be the most common finding on brain MRI in Rasmussen’s syndrome?

    <p>Cortical atrophy</p> Signup and view all the answers

    A 12-year-old boy presents with a history of progressively worsening frequency and severity of daily myoclonic seizures. What would be the best antiepileptic medication to try first, given there are no contraindications?

    <p>Valproic acid</p> Signup and view all the answers

    Which of the following choices is a characteristic associated with fosphenytoin as compared with phenytoin?

    <p>Faster rate of IV administration is possible</p> Signup and view all the answers

    Which of the following is the least likely to be associated with worsening of myoclonic seizures?

    <p>Lamotrigine</p> Signup and view all the answers

    Which of the following antiepileptic medications is a hepatic enzyme inhibitor?

    <p>Carbamazepine</p> Signup and view all the answers

    Which of the following electroencephalographic findings would be associated with the highest incidence of seizures?

    <p>6-Hz spike and wave</p> Signup and view all the answers

    At what age do human beings attain the predominant α-frequency (posterior background) that is seen in adults?

    <p>10 to 12 years</p> Signup and view all the answers

    A 47-year-old woman presents with confusion, fever, and seizures. Cerebrospinal fluid (CSF) studies are positive for HSV infection. What would be the most likely finding on an electroencephalogram (EEG) in this patient?

    <p>Periodic lateralized epileptiform discharges</p> Signup and view all the answers

    In a patient with absence epilepsy, which of the following antiepileptic medications is least likely to precipitate absence status epilepticus?

    <p>Lamotrigine</p> Signup and view all the answers

    Which of the following antiepileptic medications is the most likely to have an effect on steroid hormone concentration in the blood in patients taking oral contraceptive pills and, therefore, lead to contraceptive failure?

    <p>Carbamazepine</p> Signup and view all the answers

    Which of the following is the most likely diagnosis for a patient with stimulus-sensitive myoclonus, GTC seizures, clumsiness, frequent falls, and a genetic EPM1 gene mutation?

    <p>Unverricht–Lundborg syndrome</p> Signup and view all the answers

    In a patient with absence epilepsy, what is the least likely predictor of developing subsequent epilepsy?

    <p>Family history of FS</p> Signup and view all the answers

    In the case of a patient with unexplained seizures and general symptoms, which test should be ordered next following the patient's history of seizures?

    <p>Free and total phenytoin level</p> Signup and view all the answers

    Which of the following statements is true according to the American Academy of Neurology guidelines for an unprovoked first seizure in adults?

    <p>There is good evidence to support the need to order routine blood count, glucose, and electrolytes for first seizure</p> Signup and view all the answers

    Within what period of time starting from the first seizure is an adult at highest risk of seizure recurrence?

    <p>Within the first 2 years</p> Signup and view all the answers

    Study Notes

    Antiepileptic Drugs (AEDs) and Pregnancy

    • Lamotrigine is the safest choice for use during pregnancy compared to phenytoin, carbamazepine, valproic acid, and phenobarbital.

    Weight Loss and AEDs

    • Topiramate is the AED most commonly associated with weight loss.

    Mesial Temporal Lobe Epilepsy Symptoms

    • Typical seizures include olfactory hallucinations, altered consciousness, complex partial seizures, and automatisms. Tonic posturing of one limb is not characteristic.

    Drug Interactions and AEDs

    • Gabapentin has the least drug-drug interactions among AEDs.

    Treatment for Refractory Epilepsy in Young Children

    • The ketogenic diet is the next best treatment choice for children with generalized epilepsy unresponsive to multiple medications.

    Simple Febrile Seizures (FS) Treatment

    • Supportive management is the best approach for simple febrile seizures.

    Genes Associated with Generalized Epilepsy with Febrile Seizures Plus (GEFS+)

    • Mutations in the SCN1A gene are most commonly associated.

    Rasmussen’s Syndrome MRI Findings

    • Cortical atrophy is the most common MRI finding in Rasmussen’s syndrome.

    Progressive Myoclonic Epilepsy (PME) Treatment

    • Valproic acid is the best initial treatment for a boy suspected of PME.

    Fosphenytoin vs. Phenytoin

    • Fosphenytoin achieves therapeutic plasma concentrations faster and allows for a faster rate of IV administration compared to phenytoin.

    AEDs and Myoclonic Seizures

    • Lamotrigine is least likely to worsen myoclonic seizures.

    Hepatic Enzyme Inhibition by AEDs

    • Phenytoin, carbamazepine, valproic acid, phenobarbital, and primidone demonstrate hepatic enzyme inhibition.

    EEG Findings and Seizure Incidence

    • The 6-Hz spike and wave pattern is associated with the highest incidence of seizures.

    Development of Adult EEG Features

    • Adult predominant α-frequency is typically attained at 6 to 8 years of age.

    HSV Infection and EEG Findings

    • In HSV encephalitis, EEG findings often display periodic lateralized epileptiform discharges.

    Absence Status Epilepticus and AEDs

    • Phenytoin is least likely to precipitate absence status epilepticus.

    Interaction of AEDs with Oral Contraceptives

    • Topiramate is most likely to affect steroid hormone concentrations, leading to contraceptive failures.

    Seizure Disorders in Infancy and Childhood

    • Common diagnoses in young children with seizures include Dravet’s syndrome, Ohtahara’s syndrome, and benign myoclonic epilepsy of infancy.

    Predictors of Recurrence in Febrile Seizures

    • Complex febrile seizures and shorter fever duration are significant predictors of recurrence.

    Genetic Testing in PME

    • EPM1 gene mutation is associated with a juvenile myoclonic epilepsy that features stimulus-sensitive myoclonus and GTC seizures.

    Differential Diagnosis of EEG Findings

    • Periodic- acid-Schiff-positive inclusions observed in biopsies correlate with certain genetic epileptic syndromes.

    Surgical Considerations in Rasmussen’s Encephalitis

    • Seizures are typically not well controlled with AEDs, and histopathological findings include perivascular cuffs and glial nodules.

    AED Use in the Elderly

    • Age-related physiological changes lead to a decrease in renal blood flow and glomerular filtration rate, affecting drug clearance.

    Adverse Effects of Valproic Acid

    • Common side effects include tremors, hepatotoxicity, and hyperammonemia; however, neural tube defects are a notable risk for mothers during pregnancy.

    Behavioral Changes from AED Treatment

    • Levetiracetam is associated with behavioral changes, including increased aggression or irritability post-initiation.

    Guidelines for Unprovoked Seizures

    • EEG is advised for first unprovoked seizures, while CT or MRI has limited evidence. Routine blood work is recommended.

    Risk of Seizure Recurrence

    • The highest risk for seizure recurrence post-first seizure is within the first two years.

    Initiation of AED Therapy

    • Delaying AED therapy after the first seizure is a common practice inputting normal findings from EEGs.

    EEG Frequency Characteristics

    • α-frequency is defined as frequencies greater than 13 Hz, while β-frequency is between 8 and 13 Hz, with δ-frequency indicating lower frequencies.

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    Description

    Test your knowledge on antiepileptic drugs (AEDs) and their implications in pregnancy and weight management. This quiz covers key aspects of AED safety, drug effectiveness, and specific patient scenarios. Review your understanding of how different AEDs function and their side effects.

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