Epilepsy MCQs

Approaches to Lessen Gaps in Epilepsy Care

• Wearable devices for seizure detection and telemedicine are suggested ways to reduce gaps in epilepsy care.

Location of Level 4 Epilepsy Centers

• Level 4 epilepsy centers in the United States are often located in highly populated urban areas.

Incompatibility with Health Disparities

• Health equity is incompatible with health disparities.

Cross-Sectional Association Between Epilepsy and Cardiovascular Disease

• The cross-sectional association between epilepsy and cardiovascular disease has a bidirectional effect because either condition can precede and cause the other.

Antiseizure Medications and Metabolic Syndrome

• Valproic acid and enzyme-inducing antiseizure medications are associated with the development of atherosclerotic risk factors like dyslipidemia and metabolic syndrome.

SSRIs for Depression in Epilepsy

• Citalopram, escitalopram, and sertraline are preferred SSRIs for people with epilepsy experiencing moderate to severe depression.
• These SSRIs have minimal interaction with cytochrome P450 isoenzymes, leading to a low risk of interaction with antiseizure medications.

New-Onset Epilepsy in Older Adults

• New-onset epilepsy may be an early sign of Alzheimer's disease, reflecting shared neuropathologic features.

Serum Concentrations of Medications During Pregnancy

• Serum concentrations of valproic acid remain relatively stable during pregnancy.
• During pregnancy, the serum concentrations of lacosamide, lamotrigine, oxcarbazepine, and topiramate decrease significantly.

Antiseizure Medications and Congenital Malformations

• Levetiracetam has the lowest risk of major fetal congenital malformations among the antiseizure medications.

Antiseizure Medications and Hormone Levels

• Perampanel decreases progestin levels but does not decrease estrogen levels.
• Other antiseizure medications decrease both progestin and estrogen levels.

Antiseizure Medications and Sexual Dysfunction

• Lamotrigine has been associated with no or minimal sexual dysfunction.

Treatment Strategies for Nonepileptic Events

• Cognitive-behavioral therapy is a preferred treatment strategy for nonepileptic events as it reduces seizure frequency and improves quality of life.
• Other psychotherapy modalities can be beneficial.

Diagnosing Nonepileptic Events

• Reviewing video of events with the patient can assist in understanding the diagnosis and differentiating between epileptic and nonepileptic events.
• Antiseizure medications should be reduced slowly and one at a time.
• Referring to the spells as "pseudoseizures" is inappropriate as it can be dismissive and stigmatizing.
• Initiating a trial of antidepressant medication or recommending no further follow-up, without further evaluation is unsuitable.

Positive Signs for Diagnosing Nonepileptic Events

• Closed eyes are a positive sign during a patient's typical event, with both high specificity and high sensitivity for the diagnosis of nonepileptic events.

Ictal Features and Association with Nonepileptic Events

• Alternating limb movement during an event demonstrates a strong association with nonepileptic events.

Side Effects of the Ketogenic Diet

• Common side effects of the ketogenic diet include constipation, vomiting, diarrhea, weight loss, lethargy, hyperlipidemia, and hypercalciuria.

Sensors in FDA-Cleared Wrist-Worn Device

• A US Food and Drug Administration (FDA) cleared wrist-worn device uses accelerometry and electrodermal activity to detect seizures.

Surgical Interventions for Seizure Freedom

• Functional hemispherectomy is most likely to result in seizure freedom for patients with focal seizures arising from a large unilateral structural lesion.

Newly Approved Antiseizure Medications

• Cenobamate is indicated for the treatment of focal-onset seizures in adults as of 2018.
• Cannabidiol, fenfluramine, ganaxolone, and stiripentol have indications exclusive to specific epilepsy syndromes like Dravet syndrome, Lennox-Gastaut syndrome, and tuberous sclerosis.

Benefits of Brivaracetam vs. Levetiracetam

• Brivaracetam has a lower risk of behavioral adverse effects compared to levetiracetam.

Antibiotics and Carbamazepine Toxicity

• Co-administration of erythromycin is most likely to result in carbamazepine toxicity.
• Carbamazepine is mainly metabolized in the liver using cytochrome P450 3A4 (CYP 3A4) so it accumulates when coadministered with inhibitors of this enzyme, which covers macrolide antibiotics (except azithromycin).

Treatment Options for Seizure Clusters

• Intranasal midazolam is most likely to quickly interrupt an acute repetitive seizure cluster without requiring a trip to the emergency department.

Outcomes of Immediate Antiseizure Medication Treatment

• Immediate antiseizure medication treatment in adults is likely to decrease recurrence risk within 2 years.

Drivers of Immediate Antiseizure Medication Treatment

• Availability of antiseizure medications with lower risks of adverse effects and better pharmacokinetic profiles is an important driver toward immediate antiseizure medication treatment after a first unprovoked seizure.

Genetic Tests for Unexplained Epilepsy

• Exome sequencing is considered the first-line genetic test for most patients with unexplained epilepsy where a genetic etiology is suspected
• Genome sequencing has a higher yield than exome sequencing but cost limits use as a first-line test.

Genetic Abnormalities in Self-Limited Epilepsies

• Ion channel disorders are the most common genetic abnormality that underlies self-limited epilepsies in neonates and infants.

Genetic Testing for Patients With Epilepsy

• Genetic testing has the highest yield in patients with a developmental and epileptic encephalopathy and intellectual disability, autism spectrum disorder, dysmorphic features, or other neurodevelopmental comorbidities.

Imaging Techniques for Seizure-Onset Zone

• Fludeoxyglucose positron emission tomography (FDG-PET) best demonstrates a hypometabolic area associated with the seizure-onset zone.

Characteristics of Ganglioglioma on MRI

• A ganglioglioma typically appears as a cyst with a contrast-enhancing mural nodule on MRI.

Components for Harmonized Neuroimaging in Epilepsy

• Three-dimensional high-resolution fluid-attenuated inversion recovery (FLAIR) and three-dimensional high-resolution T1-weighted sequences are components of the Harmonized Neuroimaging of Epilepsy Structural Sequences protocol.

Likelihood of Normal Ictal EEG

• Ictal EEG is most likely to be normal in focal seizures without impairment of awareness (simple partial seizures) due to the electrical activity.

Patient Diagnoses and EEG Results

• Toxic encephalopathy is likely in a 55-year-old with relapsed large B-cell lymphoma, verbal fluency impairment, 6 days post-chimeric antigen receptor T-cell infusion, and frontal intermittent rhythmic delta activity on EEG.

Preferred Diagnostic Test & Daily Activities

• Prolonged ambulatory EEG is preferred for individuals with events provoked by daily activities.
• Prolonged ambulatory EEGs allow capturing daily triggers that may not occur otherwise.

Diagnosis of Routine EEG

• Focal epilepsy can be diagnosed from routine EEG results if exhibiting a single right temporal sharpwave with a slow after-wave that disrupts background activity.

Childhood-Onset Generalized Epilepsy Syndrome

• Epilepsy with eyelid myoclonia is classified as a childhood-onset generalized epilepsy syndrome according to the International League Against Epilepsy.
• Childhood occipital visual epilepsy is self-limited.
• Dravet syndrome is a developmental and epileptic encephalopathy, and epilepsy with generalized tonic-clonic seizures alone is a generalized epilepsy with variable age of onset.

Characteristics of Atypical Absence Seizures

• Prominent alteration in tone is more characteristic with atypical absence seizures than typical absence seizures.

Appropriate Classification of Seizures

• Tonic-clonic seizure of unknown onset is the appropriate classification because the onset of these seizures has not been observed.

Classification of Sensory Seizure

• Focal sensory seizure with impaired awareness is the appropriate classification, given the initial sensory manifestation and impaired awareness.