Questions and 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?
Which of the following AEDs is associated with weight loss?
The clinical features of seizures in mesial temporal lobe epilepsy may have all of the following characteristic symptoms, except:
Which of the following AEDs would have the least drug–drug interactions?
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In a young child with generalized epilepsy refractory to multiple antiepileptic medications, what would be the next best choice of treatment, if tolerated?
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Which of the following is the best treatment option for simple febrile seizures (FSs)?
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Mutations in which of the following genes is most commonly associated with generalized epilepsy with febrile seizures plus (GEFS+)?
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A 13-year-old girl is being evaluated for epilepsia partialis continua. What would be the most common finding on brain MRI in Rasmussen’s syndrome?
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What would be the best antiepileptic medication to try first in a 12-year-old boy with progressively worsening myoclonic seizures?
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Which of the following choices is a characteristic associated with fosphenytoin as compared with phenytoin?
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Which of the following is the least likely to be associated with worsening of myoclonic seizures?
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Which of the following antiepileptic medications is a hepatic enzyme inhibitor?
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Which of the following electroencephalographic findings would be associated with the highest incidence of seizures?
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At what age do human beings attain the predominant alpha-frequency that is seen in adults?
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A 47-year-old woman presents with confusion, fever, and seizures. What would be the most likely finding on an electroencephalogram (EEG) in this patient?
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In a patient with absence epilepsy, which of the following antiepileptic medications is least likely to precipitate absence status epilepticus?
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Study Notes
Antiepileptic Drugs and Pregnancy
- Lamotrigine is the safest antiepileptic drug (AED) during pregnancy, associated with lower teratogenic risk.
- Monitoring of lamotrigine levels is necessary as clearance increases during pregnancy, requiring dosage adjustments.
Antiepileptic Drugs and Weight Management
- Topiramate is known for weight loss in patients, beneficial for those with obesity.
- Other AEDs, including pregabalin, gabapentin, carbamazepine, and valproic acid, are typically associated with weight gain.
Seizure Characteristics in Temporal Lobe Epilepsy
- Mesial temporal lobe epilepsy can present with olfactory hallucinations, altered consciousness, complex partial seizures, and automatisms.
- Tonic posturing of one limb (fencer’s posture) is indicative of frontal lobe seizures, not temporal lobe epilepsy.
Drug Interactions among Antiepileptic Medications
- Gabapentin has minimal drug-drug interactions as it is not metabolized by the liver.
- Other AEDs like carbamazepine and valproic acid can interact with various medications due to hepatic enzyme effects.
Treatment Options for Refractory Epilepsy
- The ketogenic diet is an effective treatment for children with refractory epilepsy, promoting ketosis as an energy source.
- Surgical options and vagus nerve stimulation are secondary to dietary therapy.
Management of Simple Febrile Seizures
- Supportive management, focusing on child safety and monitoring, is the best approach for simple febrile seizures.
- Antipyretics may help reduce fever but do not prevent seizure occurrences.
Genetic Associations with Generalized Epilepsy
- Mutations in the SCN1A gene, involved in neuronal sodium channels, are commonly linked to generalized epilepsy with febrile seizures plus (GEFS+).
MRI Findings in Rasmussen’s Syndrome
- Progressive unilateral cortical atrophy is typically observed in Rasmussen’s syndrome due to chronic inflammation.
Myoclonic Epilepsy Treatment
- Valproic acid is first-line treatment for myoclonic seizures, effective in increasing GABA levels and controlling seizures.
Fosphenytoin vs. Phenytoin
- Fosphenytoin allows a faster rate of intravenous administration compared to phenytoin, reducing the risk of cardiac reactions.
Worsening Myoclonic Seizures
- Topiramate is less likely to exacerbate myoclonic seizures, whereas carbamazepine and other AEDs may increase seizure frequency.
Hepatic Enzyme Activity of AEDs
- Valproic acid is a hepatic enzyme inhibitor, potentially increasing levels of other drugs, while several other AEDs are inducers.
EEG Findings in Various Conditions
- The 3-Hz spike-and-wave pattern is indicative of absence epilepsy and has a high seizure incidence.
- Periodic lateralized epileptiform discharges (PLEDs) are typical in HSV encephalitis cases.
Age and EEG Patterns
- Children reach the adult pattern of posterior dominant alpha rhythm on EEG between ages 8 and 10.
Absence Epilepsy and AEDs
- Topiramate is least likely to precipitate absence status epilepticus and can be safely used for absence seizures.
Immediate AED Therapy
- Starting AED therapy after a first unprovoked seizure can significantly reduce recurrence risk in the following two years.
EEG Characteristics
- Eye closure during EEG impacts posterior dominant alpha rhythm, confirming normal reactivity; mental state may differ during recording.
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Description
This quiz explores the effects of antiepileptic drugs during pregnancy, weight management, and characteristics of seizures in temporal lobe epilepsy. Gain insights into drug interactions and the safety of various AEDs for different patient needs.
