Antiepileptic Drugs and Epilepsy Management
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Questions and Answers

How long is there no chance of seizure recurrence for this patient?

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

    • Which of the following statements is true regarding the 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
  • The potential AED adverse effects are generally severe and some may be irreversible (correct)
  • Immediate AED therapy as compared with the delay of treatment pending a second seizure is likely to improve quality of life
  • 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?

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

    • Which of the following is correct regarding EEG frequencies?

    <p>α-frequency is &gt;13 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

    In Rasmussen’s syndrome, what would be the most common finding on brain MRI?

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

    In a case of suspected progressive myoclonic epilepsy (PME), 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>3-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>6 to 8 years</p> Signup and view all the answers

    In a patient with cerebrospinal fluid studies positive for HSV infection, what would be the most likely finding on an electroencephalogram (EEG)?

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

    In a newborn with seizures characterized by apneic spells and clonic movements starting on day 5 of life, what is the most likely diagnosis?

    <p>Ohtahara’s syndrome</p> Signup and view all the answers

    In a 4-year-old boy with visual phenomena during seizures, what is the most likely diagnosis given the EEG findings?

    <p>Early-onset or Panayiotopoulos-type childhood occipital epilepsy</p> Signup and view all the answers

    In a 3-year-old boy with diverse seizure types and an EEG showing 2-Hz spike–wave discharges, what is the most likely diagnosis?

    <p>Lennox–Gastaut syndrome</p> Signup and view all the answers

    In a 5-year-old boy with myoclonic seizures worsening over time and EEG showing multifocal spikes, what is the most likely diagnosis?

    <p>Landau–Kleffner syndrome</p> Signup and view all the answers

    In a 15-year-old girl with seizures starting with eye and head deviation toward the left, where is the most likely location of the seizure focus?

    <p>Left temporal lobe</p> Signup and view all the answers

    In an 18-year-old man with asymmetric tonic posturing and GTC seizures, where is the most likely location of the seizure focus?

    <p>Left supplementary motor area</p> Signup and view all the answers

    In a 32-year-old woman experiencing dystonic seizures with automatisms, where is the most likely location of the seizure focus?

    <p>Left supplementary motor area</p> Signup and view all the answers

    In a 7-year-old boy with uncontrollable episodes of laughter, where is the most likely origin of his seizures?

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

    In a 56-year-old woman with a history of seizures and now presenting with dysarthria, what test should be ordered next?

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

    In a 2-year-old girl experiencing a generalized seizure, which factor is NOT a predictor of recurrence of febrile seizures (FS)?

    <p>Lower peak temperature at the time of FS</p> Signup and view all the answers

    In a patient who suffered a febrile seizure (FS), which is the least likely predictor of developing subsequent epilepsy?

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

    In a 14-year-old boy with myoclonic epilepsy and generalized spikes on EEG, what is the most likely diagnosis given a confirmed EPM1 gene mutation?

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

    For a 12-year-old boy diagnosed after a viral illness with seizures and lactic acidosis, which feature is part of his condition?

    <p>This is a mitochondrial disorder</p> Signup and view all the answers

    In a 21-year-old man with progressive myoclonic jerks and a cherry red spot, what is the most likely diagnosis?

    <p>Lafora body disease</p> Signup and view all the answers

    In a 14-year-old boy with multiple seizure types and spikes on EEG, which finding is most likely during evaluation?

    <p>Ragged red fibers on muscle biopsy</p> Signup and view all the answers

    In a 12-year-old boy with Rasmussen's encephalitis, what is true regarding his condition?

    <p>Histopathology shows perivascular cuffs of lymphocytes and monocytes, as well as glial nodules in the gray and white matter</p> Signup and view all the answers

    Regarding the use of AEDs in the elderly, which of the following statements is correct?

    <p>Gastric acidity may decrease, making weakly basic drugs less easily absorbed and weakly acidic drugs more easily absorbed</p> Signup and view all the answers

    In an 18-year-old woman starting valproic acid for juvenile myoclonic epilepsy, which side effect is least likely?

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

    In a 67-year-old man's behavioral changes after a new medication, which of the following medications is likely responsible?

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

    In a 59-year-old man diagnosed with acute closed-angle glaucoma after starting a new AED, which medication is most likely responsible?

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

    In a 42-year-old man with an unprovoked first seizure, what statement is true according to guidelines?

    <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

    Study Notes

    Antiepileptic Drugs (AEDs) and Pregnancy

    • Lamotrigine is the safest choice among AEDs during pregnancy.
    • Other options like Phenytoin, Carbamazepine, Valproic acid, and Phenobarbital have lesser safety evidence.

    Weight Loss and AEDs

    • Topiramate is the AED most associated with weight loss.
    • Pregabalin, Gabapentin, Carbamazepine, and Valproic acid do not show significant weight loss effects.

    Mesial Temporal Lobe Epilepsy

    • Characteristic symptoms include olfactory hallucinations, altered consciousness, complex partial seizures, and automatisms.
    • Tonic posturing of one limb is not typically associated.

    Drug Interactions with AEDs

    • Gabapentin has the least drug-drug interactions among the AEDs listed.
    • Carbamazepine, Valproic acid, Lamotrigine, and Phenytoin can lead to significant interactions.

    Treatment for Refractory Epilepsy in Young Children

    • The ketogenic diet is a preferred option for a young child with generalized epilepsy refractory to multiple AEDs when tolerated.
    • Other options like corpus callosotomy, vagus nerve stimulation, Phenytoin, and Carbamazepine are less favored.

    Simple Febrile Seizures Management

    • Supportive management is the best treatment option for simple febrile seizures.
    • Other treatments like IV lorazepam, rectal diazepam, phenobarbital, and intranasal midazolam are less appropriate.

    Genetic Associations with Epilepsy

    • Mutations in the SCN1A gene are most commonly linked with generalized epilepsy with febrile seizures plus (GEFS+).
    • Other genes like SCN1C, SCN1B, SCN2A, and GABRD are less common.

    Rasmussen’s Syndrome Imaging Findings

    • Cortical atrophy is the most common MRI finding in Rasmussen’s syndrome.
    • Other options like lissencephaly, schizencephaly, pachygyria, and porencephaly are less typical.

    Progressive Myoclonic Epilepsy (PME)

    • Valproic acid is the best initial AED for suspected PME without contraindications.
    • Carbamazepine, Phenytoin, Oxcarbazepine, and Gabapentin are less favored.

    Fosphenytoin vs. Phenytoin

    • Fosphenytoin achieves therapeutic plasma concentrations faster and allows a faster IV administration rate.
    • It does not cause dizziness or nystagmus but may lead to more cardiovascular side effects and infiltration reactions.

    Myoclonic Seizures and AEDs

    • Topiramate is least likely to worsen myoclonic seizures.
    • Carbamazepine, Lamotrigine, Pregabalin, and Vigabatrin have a higher risk.

    Hepatic Enzyme Inhibitors

    • Phenytoin, Carbamazepine, and Phenobarbital act as hepatic enzyme inducers.
    • Valproic acid is a potent enzyme inhibitor.

    EEG Findings and Seizure Incidence

    • 3-Hz spike and wave patterns are associated with the highest incidence of seizures.
    • Other patterns like small sharp spikes, 6-Hz spike and wave, wicket spikes, and positive spikes are less indicative.

    Development of α-frequency

    • Human beings typically achieve predominant α-frequency by ages 6 to 8 years.
    • This frequency is crucial for later brain development.

    HSV and EEG Findings

    • In cases of HSV infection, periodic lateralized epileptiform discharges may be observed on EEG.
    • Other findings such as triphasic waves, wicket spikes, polyspikes, and fast spike-wave complexes are less likely.

    Absence Epilepsy Treatment

    • Phenytoin is least likely to worsen absence status epilepticus.
    • Other medications like Topiramate, Carbamazepine, Lamotrigine, and Gabapentin may exacerbate the condition.

    Contraceptive Interactions with AEDs

    • Topiramate can significantly affect steroid hormone levels, potentially leading to contraceptive failure.
    • Other agents like Levetiracetam and Gabapentin have fewer interactions.

    Progressive Myoclonic Epilepsy Diagnosis

    • EPM1 gene mutation correlates with Unverricht–Lundborg syndrome.
    • Symptoms include myoclonus, GTC seizures, ataxia, and impaired coordination.

    Lennox-Gastaut Syndrome EEG Findings

    • 2-Hz spike-wave discharges are characteristic of Lennox-Gastaut syndrome.
    • Various seizure types typically coexist, complicating the clinical picture.

    Epileptic Disorders in Children

    • Conditions like West syndrome, Landau-Kleffner syndrome, and others manifest different EEG patterns and seizure types.
    • Diagnosis often relies on the patient's age, EEG characteristics, and clinical history.

    Surgical Considerations in Epilepsy

    • Rasmussen’s encephalitis often necessitates surgical intervention due to refractory seizures and cognitive decline.
    • EEG shows status epilepticus originating from the affected hemisphere.

    AED Guidelines for First Seizures

    • The American Academy of Neurology advises routine blood tests, but FAQs exist around EEG necessity and imaging.
    • High recurrence risk is present within the initial two years post-first seizure.

    Evaluation of AEDs in Elderly Patients

    • Changes in drug distribution, metabolism, and absorption vary with aging.
    • AED selection must consider these pharmacokinetic alterations to ensure patient safety and efficacy.

    Side Effects of AEDs

    • Possible side effects of Valproic acid include tremors, hepatotoxicity, hyperammonemia, and potential for birth defects.
    • Adverse effects should be weighed against benefits in seizure management.

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    Description

    This quiz covers essential information on antiepileptic drugs (AEDs), their safety during pregnancy, weight loss implications, and the management of refractory epilepsy in children. Test your knowledge on specific AEDs like Lamotrigine, Topiramate, and their interactions. Explore symptoms related to mesial temporal lobe epilepsy and understand treatment options.

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