Questions and Answers
Which antiepileptic drug (AED) is considered the safest choice during pregnancy in terms of evidence?
What is a common side effect of Topiramate?
Which symptom is least likely to occur in mesial temporal lobe epilepsy?
Which AED is known for having minimal drug–drug interactions?
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Which antiepileptic drug carries the highest teratogenic risk during pregnancy?
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A patient's seizure disorder is monitored due to increased clearance of which AED during pregnancy?
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Which of the following AEDs is NOT typically associated with seizures features like automatisms?
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Which AED is more likely to cause sedation and cognitive side effects than weight loss?
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At what age do children typically develop the adult pattern of posterior dominant alpha rhythm on EEG?
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What EEG finding is most likely in a patient with HSV encephalitis?
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Which antiepileptic medication is least likely to precipitate absence status epilepticus?
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Which antiepileptic medication can potentially affect steroid hormone concentrations in patients on oral contraceptives?
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What is the implication of initiating antiepileptic drug therapy after an unprovoked first seizure?
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Which statement is correct regarding the EEG results when an eye closure is recorded?
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Which frequency range is correctly matched to its EEG type?
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Which of the following findings would not typically be observed in EEG readings during a sleep study?
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What is a typical characteristic of periodic lateralized epileptiform discharges (PLEDs)?
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What is the primary reason to avoid certain antiepileptic drugs in a patient with absence seizures?
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Which antiepileptic medication is least likely to have drug interactions due to hepatic metabolism?
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What is the next best choice of treatment for a young child with generalized epilepsy refractory to multiple antiepileptic medications?
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What is the best management approach for simple febrile seizures?
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Which gene mutation is most commonly linked with generalized epilepsy with febrile seizures plus?
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What MRI finding is most characteristic of Rasmussen’s syndrome?
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What is the first-line treatment for a patient suspected of having progressive myoclonic epilepsy?
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Which characteristic is true of fosphenytoin when compared to phenytoin?
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Which antiepileptic medication is least likely to exacerbate myoclonic seizures?
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Which of the following medications is a hepatic enzyme inhibitor?
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What electroencephalographic finding is associated with a high incidence of seizures?
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At what age do human beings predominantly attain the alpha-frequency observed in adults?
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What dietary intervention may be effective for children with refractory epilepsy?
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Which of the following is a common first-line treatment for myoclonic seizures?
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Which drug is known to potentially cause purple glove syndrome?
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Study Notes
Antiepileptic Drugs (AEDs) in Pregnancy
- Lamotrigine is regarded as the safest AED during pregnancy, associated with a lower risk of major congenital malformations.
- Other AEDs, such as valproic acid, carry higher teratogenic risks.
Weight and AEDs
- Topiramate can lead to weight loss, beneficial for patients with obesity-related health issues.
- Common AEDs that typically cause weight gain include pregabalin, gabapentin, carbamazepine, and valproic acid.
Seizures and Temporal Lobe Epilepsy
- Mesial temporal lobe epilepsy often presents with olfactory hallucinations, altered consciousness, complex partial seizures, and automatisms.
- Tonic posturing of one limb (fencer’s posture) is characteristic of frontal lobe seizures.
Drug-Drug Interactions
- Gabapentin has minimal drug-drug interactions as it is not metabolized by the liver and is excreted unchanged by the kidneys.
Pediatric Refractory Epilepsy Treatment
- The ketogenic diet is an effective treatment for children with refractory epilepsy, changing the body’s energy source to ketones.
- Surgical options are considered after dietary strategies.
Febrile Seizures Management
- Supportive management is the best approach for simple febrile seizures, as they are usually self-limiting.
Genetic Factors in Epilepsy
- GEFS+ is commonly associated with mutations in the SCN1A gene, affecting neuronal sodium channels.
Rasmussen's Syndrome
- Brain MRI in Rasmussen’s syndrome typically shows progressive unilateral cortical atrophy, reflecting chronic inflammation and neuron loss.
Myoclonic Seizures Treatment
- Valproic acid is often the first-line treatment for progressive myoclonic epilepsy, increasing GABA levels.
Fosphenytoin Characteristics
- Fosphenytoin allows for faster intravenous administration compared to phenytoin and is less likely to cause cardiac issues.
Myoclonic Seizures and Topiramate
- Topiramate is less likely to exacerbate myoclonic seizures and is utilized in their treatment.
Hepatic Enzyme Activity of AEDs
- Valproic acid is a hepatic enzyme inhibitor, raising levels of other liver-metabolized drugs.
EEG Patterns in Seizures
- The 3-Hz spike-and-wave pattern on EEG is characteristic of absence epilepsy, indicating a high incidence of seizures.
Development of Alpha Rhythm
- By ages 8 to 10 years, children typically develop the adult-type posterior dominant alpha rhythm on EEG.
HSV Encephalitis and EEG Findings
- Periodic lateralized epileptiform discharges (PLEDs) are frequently seen in cases of HSV encephalitis.
Absence Epilepsy Medication Effects
- Topiramate is least likely to precipitate absence status epilepticus, making it a safer option compared to other AEDs.
AEDs and Hormonal Interactions
- Certain AEDs, particularly those affecting liver enzymes, have the potential to alter steroid hormone levels, which could impact contraception.
Timing of AED Therapy
- Initiating AED therapy after the first unprovoked seizure can reduce seizure recurrence risk in the following two years, though the long-term remission effect is variable.
EEG Reactivity
- Reactivity of the posterior background in EEG can be assessed through eye closure, indicating normal brain activity in awake patients.
EEG Frequency Classification
- EEG frequency ranges include alpha frequency (8-13 Hz), beta frequency (>13 Hz), and delta frequency (0.5-4 Hz), which are important for understanding brain activity during seizures.
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Description
This quiz covers the implications of antiepileptic drugs (AEDs) during pregnancy, their impact on weight, and their role in treating different types of epilepsy. It also addresses drug-drug interactions and treatment options for pediatric refractory epilepsy. Test your knowledge on these crucial topics in epilepsy management.
