Understanding Seizures and Epilepsy

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Which of the following statements correctly distinguishes between a seizure and epilepsy? A) A seizure is caused by excessive electrical discharge from the cerebral cortex, while epilepsy refers to any one-time, provoked event of such discharge. B) A seizure involves an imbalance between excitation and inhibition in the brain, while epilepsy refers to recurrent unprovoked seizures. C) A seizure is always a sign of epilepsy, whereas epilepsy is a type of seizure. D) Seizures and epilepsy are the same, as both involve excessive electrical discharges in the brain.

A seizure is caused by excessive electrical discharge from the cerebral cortex, while epilepsy refers to any one-time, provoked event of such discharge.

A seizure involves an imbalance between excitation and inhibition in the brain, while epilepsy refers to recurrent unprovoked seizures. (correct)

A seizure is always a sign of epilepsy, whereas epilepsy is a type of seizure.

Seizures and epilepsy are the same, as both involve excessive electrical discharges in the brain.

Which of the following best describes the cause of a seizure?

A disruption in blood flow leading to brain damage.

An imbalance between excitatory and inhibitory signals in the brain. (correct)

A decrease in the number of neurons in the brain.

A viral infection that attacks the brain cells.

The symptoms of a seizure primarily depend on:

The age of the individual.

The location of the electrical discharge in the brain. (correct)

The severity of the head injury.

The underlying cause of the imbalance.

How does epilepsy differ from a single seizure?

Epilepsy involves recurrent unprovoked seizures, whereas a seizure is typically a one-time event. Signup and view all the answers

Epilepsy is a ______ disorder of the central nervous system (CNS), characterized by recurrent seizures. How many seizures are required for a diagnosis of epilepsy?

Heterogeneous Signup and view all the answers

How many seizures must occur for a diagnosis of epilepsy?

At least two seizures, or one with electrographic (EEG) evidence of epileptiform activity. Signup and view all the answers

What is a key feature of epilepsy in terms of its presentation?

It is characterized by diverse etiologies, multiple seizure types, and variable prognoses. Signup and view all the answers

What is an unprovoked seizure?

A seizure with an unknown etiology, or one associated with a preexisting brain lesion or progressive disorder. Signup and view all the answers

What is the key difference between provoked and unprovoked seizures?

Provoked seizures occur in response to systemic processes such as intoxication or acute brain injury, while unprovoked seizures have no known cause or are related to preexisting conditions. Signup and view all the answers

What type of seizure involves seizure activity starting in one area of the brain?

Focal Signup and view all the answers

Which of the following best describes generalized seizures?

Seizure activity involves both hemispheres of the brain. Signup and view all the answers

What is the characteristic feature of an absence seizure?

Brief episodes of staring, typically without physical convulsions. Signup and view all the answers

Which seizure type involves muscle jerks but no loss of consciousness?

Myoclonic seizure Signup and view all the answers

What does a myoclonic atonic seizure involve?

Sudden muscle jerks followed by loss of muscle tone. Signup and view all the answers

Which of the following seizure types is characterized by sudden muscle tone loss, often causing falls?

Atonic seizure Signup and view all the answers

What type of seizure is categorized as having an unknown onset?

Epileptic spasm Signup and view all the answers

Which of the following describes a seizure with alternating muscle contractions and relaxation?

Clonic seizure Signup and view all the answers

Which of the following is true about a tonic seizure?

It involves stiffening of muscles, often leading to falls. Signup and view all the answers

Epilepsy syndromes are defined by which of the following?

Complex clinical features, signs, and symptoms that define a distinctive seizure disorder. Signup and view all the answers

How are epilepsy syndromes typically identified?

Based on age of onset, seizure type(s), EEG characteristics, aetiologies, and associated comorbidities. Signup and view all the answers

Many epilepsy syndromes are now recognized to be due to which of the following?

Specific pathogenic gene mutations. Signup and view all the answers

Which of the following is a gene associated with Autosomal Dominant Nocturnal Frontal Lobe Epilepsy (NFLE)?

CHRNA2 Signup and view all the answers

Which syndrome is linked to mutations in the SCN1A gene?

Dravet syndrome Signup and view all the answers

Which of the following epilepsy syndromes is associated with a gene mutation in LGI1?

Autosomal dominant epilepsy with auditory features Signup and view all the answers

Which syndrome is commonly associated with epileptic encephalopathy due to various de novo mutations?

Dravet syndrome Signup and view all the answers

Which of the following statements is true about Juvenile Myoclonic Epilepsy (JME)?

It is characterized by myoclonic jerks, usually occurring in the morning. Signup and view all the answers

Which of the following epilepsy syndromes is most commonly associated with childhood absence seizures?

Childhood Absence Epilepsy Signup and view all the answers

Which of the following epilepsy syndromes is most likely to present with seizures that occur primarily during sleep?

Autosomal dominant nocturnal frontal lobe epilepsy (NFLE) Signup and view all the answers

How can medications influence seizure activity in patients with epilepsy?

By causing seizures if a dose is missed or when starting a new medication that interacts with anti-seizure medications (ASM). Signup and view all the answers

Which of the following factors can increase the risk of seizures during acute illnesses?

Fever Signup and view all the answers

Which of the following conditions is known to increase the risk of seizures due to potential brain injury or damage?

Stroke Signup and view all the answers

How does sleep deprivation affect seizure susceptibility?

It can trigger seizures in susceptible individuals. Signup and view all the answers

Seizures and epilepsy are caused by an imbalance between which two processes in the central nervous system?

Excitation and inhibition Signup and view all the answers

What cellular event typically leads to the onset of seizures?

Hyperexcitation and hypersynchronization of neuronal networks. Signup and view all the answers

Which of the following physiological conditions can promote seizure activity by altering neurotransmitter release?

All of the above Signup and view all the answers

How does a lower threshold for stimulation in neurons contribute to seizures?

It makes neurons hyperexcitable and more easily triggered to fire. Signup and view all the answers

What happens when the neurons in the epileptogenic focus become hyperexcitable?

They stimulate nearby normal neurons, spreading the seizure activity. Signup and view all the answers

Which of the following is a feature that may suggest a seizure in older adults?

Sudden falls with no recall or warning Signup and view all the answers

What clinical presentation is often observed when an older adult experiences a seizure?

Arousal from sleep with confusion or disorientation Signup and view all the answers

Why are seizures in older adults often difficult to recognize?

They may lack a preceding warning or aura and are often misdiagnosed as delirium. Signup and view all the answers

What is a common misdiagnosis for seizures in older adults?

Delirium Signup and view all the answers

Which of the following factors complicates the recognition of seizures in older adults?

Comorbid dementia Signup and view all the answers

What is a key feature that may suggest a seizure in older adults, particularly in the context of confusion or behavioral changes?

Sudden falls with no prior warning Signup and view all the answers

Which of the following is commonly observed before or during a tonic-clonic seizure?

Aura (sensory, motor, limbic, autonomic features) Signup and view all the answers

What motor feature is commonly seen during the tonic-clonic phase of a seizure?

Tonic/clonic movements of the face and extremities Signup and view all the answers

Which of the following is a common post-seizure feature of a tonic-clonic seizure?

Headache Signup and view all the answers

What is a hallmark sign of injury that can occur during a tonic-clonic seizure?

Tongue biting Signup and view all the answers

Which of the following is commonly observed after a tonic-clonic seizure?

Focal weakness known as 'Todd’s paralysis' Signup and view all the answers

What feature is often seen in the eyes during the tonic phase of a tonic-clonic seizure?

Eyes rolled back and fixed Signup and view all the answers

Which of the following may occur during a tonic-clonic seizure that involves the autonomic nervous system?

Urinary incontinence and cyanosis Signup and view all the answers

After a tonic-clonic seizure, what is a common postictal finding?

Deep sleep with heavy 'sterterous' breathing Signup and view all the answers

Which of the following clinical features can be seen after a tonic-clonic seizure?

Confusion and poor coordination Signup and view all the answers

What does the term "ictal" refer to in the context of seizures?

The time when the seizure is actively occurring Signup and view all the answers

Which of the following is a hallmark feature of the tonic phase of a seizure?

Sudden stiffening and rigidity of the body Signup and view all the answers

During the clonic phase of a seizure, what is typically observed?

Rhythmic jerking or convulsions of the body Signup and view all the answers

What is a common feature seen during the post-ictal phase following a seizure?

Deep sleep with heavy, noisy breathing (sterterous) Signup and view all the answers

Which of the following is commonly seen in the tonic phase of a seizure?

Loss of consciousness and rigid muscles Signup and view all the answers

Which of the following is a key characteristic of the clonic phase of a seizure?

Rhythmic jerking of the body, especially limbs Signup and view all the answers

What is a feature commonly observed after the seizure, during the post-ictal phase?

Focal weakness known as 'Todd’s paralysis' Signup and view all the answers

Which of the following conditions can mimic a seizure due to sudden loss of consciousness and involuntary movements?

Hypoglycaemia Signup and view all the answers

What condition can mimic a postictal state due to a drop in blood pressure, especially in elderly individuals?

Syncope – cardiogenic Signup and view all the answers

Which of the following is a key diagnostic tool for differentiating Non-Epileptic Attack Disorder (NEAD) from true seizures?

In-patient video EEG monitoring Signup and view all the answers

Which of the following conditions can be mistaken for a seizure due to its sudden onset of confusion and memory impairment?

Delirium and confusional states Signup and view all the answers

Which condition involves sudden, brief memory loss with no clear neurological cause, and can mimic a seizure?

Transient global amnesia Signup and view all the answers

Which of the following is considered a crucial part of the diagnosis of a seizure?

Eye-witness description of the event Signup and view all the answers

When diagnosing seizures, why is it important to ask about triggers such as recent illness or drug/alcohol use?

To rule out provoked seizures from systemic causes Signup and view all the answers

In a patient with a suspected seizure, which of the following should be ruled out first?

Causes of provoked seizures Signup and view all the answers

If a patient is known to have epilepsy, which of the following is crucial to assess during the consultation?

Whether the patient is compliant with their medication regimen Signup and view all the answers

What is the most appropriate diagnostic test to rule out hypoglycemia as a cause of seizure-like symptoms?

Blood glucose level (BLS) Signup and view all the answers

Which diagnostic test should be performed to rule out underlying arrhythmias that might mimic seizure symptoms?

ECG Signup and view all the answers

Why is lactate commonly measured during or after a seizure?

Lactate levels are typically elevated during or after a seizure. Signup and view all the answers

Which test is recommended to rule out infection or inflammation when diagnosing seizures?

FBC and CRP Signup and view all the answers

When is CT imaging typically indicated in the diagnosis of a seizure?

In emergency settings or before lumbar puncture (LP) Signup and view all the answers

In a patient with suspected meningitis or subarachnoid hemorrhage, why is CT imaging performed before lumbar puncture (LP)?

To evaluate for increased intracranial pressure Signup and view all the answers

Which of the following diagnostic tests is used to assess for non-epileptic causes of seizure-like symptoms?

Tilt-table testing Signup and view all the answers

In a patient with a first seizure, which of the following is the recommended approach for neuroimaging?

Non-contrast CT Brain followed by MRI if an intracranial lesion is suspected Signup and view all the answers

What does a normal EEG result indicate in the context of a first seizure?

A normal EEG does NOT exclude epilepsy. Signup and view all the answers

What is the main purpose of provocation testing (e.g., sleep deprivation, hyperventilation, or photic stimulation) in the diagnosis of epilepsy?

To increase the yield of EEG findings Signup and view all the answers

Which of the following is considered the gold standard for confirming the diagnosis of epilepsy?

Inpatient video-EEG monitoring Signup and view all the answers

What is the role of lumbar puncture (LP) in the investigation of a patient with suspected seizures?

To assess for intracranial infection or inflammatory disease Signup and view all the answers

What type of EEG abnormality is typically seen in generalized epileptic seizures?

Generalized epileptiform activity Signup and view all the answers

What percentage of patients will have an abnormal EEG at presentation with their first seizure?

25% Signup and view all the answers

What is the definition of status epilepticus?

A prolonged convulsive seizure lasting over 5 minutes, or a series of seizures with incomplete recovery of consciousness Signup and view all the answers

In approximately half of the cases, the cause of status epilepticus is acute symptomatic, typically due to what?

Metabolic or structural causes Signup and view all the answers

According to the '5 minute rule,' when should a seizure be treated as a medical emergency?

When a seizure lasts longer than 5 minutes Signup and view all the answers

Why is status epilepticus considered a medical emergency?

It can lead to permanent brain damage or death Signup and view all the answers

What is the first-line treatment for status epilepticus to help prevent further seizures?

Immediate administration of anti-seizure medication Signup and view all the answers

If a seizure does not stop within 5–10 minutes, what is the next step in the emergency management of status epilepticus?

Administer a second dose of a benzodiazepine Signup and view all the answers

Which of the following is considered second-line treatment in the management of status epilepticus?

Phenobarbital infusion Signup and view all the answers

Which of the following drugs is typically used for third-line management of status epilepticus if seizures persist despite initial treatment?

Propofol infusion Signup and view all the answers

What is the primary role of phenobarbital in the management of status epilepticus?

To provide sedation and suppress seizures after the first two lines of treatment Signup and view all the answers

Which drug is commonly used for the loading dose in second-line treatment of status epilepticus?

Phenytoin IV Signup and view all the answers

What is the role of benzodiazepines in the management of status epilepticus?

They are used to stop seizures during the initial phase of treatment Signup and view all the answers

In the emergency management of status epilepticus, why should the patient be positioned in the left lateral position?

To reduce the risk of aspiration Signup and view all the answers

Which of the following drugs is commonly used as a first-line treatment for status epilepticus via intravenous (IV) administration?

Lorazepam Signup and view all the answers

Which of the following drugs is commonly administered via buccal route for first-line management of status epilepticus?

Midazolam Signup and view all the answers

Which drug is administered rectally (PR) as a first-line treatment for status epilepticus?

Diazepam Signup and view all the answers

Which of the following is most commonly associated with non-convulsive status epilepticus?

Critical illness in the ICU setting Signup and view all the answers

The diagnosis of non-convulsive status epilepticus is primarily confirmed by which of the following?

EEG (Electroencephalogram) Signup and view all the answers

After how many unprovoked seizures should anti-seizure medication typically be started?

After 2 unprovoked seizures Signup and view all the answers

Which of the following is a reason for starting anti-seizure medication after just one seizure?

Epileptiform abnormalities on interictal EEG Signup and view all the answers

When should anti-seizure medication be started after a single seizure, according to chronic treatment guidelines?

When the first seizure occurs during sleep Signup and view all the answers

Which of the following findings would not justify starting anti-seizure medication after a single seizure?

Seizure triggered by a fever Signup and view all the answers

What is an important aspect of patient education for individuals with epilepsy regarding medication?

Discuss potential side effects and encourage adherence to prescribed treatment Signup and view all the answers

When counselling a patient about managing seizure triggers, which of the following is an important consideration?

Advise avoiding triggers like alcohol, poor sleep hygiene, and non-compliance with medications Signup and view all the answers

What is the minimum seizure-free period required for a Group 1 driver in Ireland (car, motorcycle, tractor) to resume driving after a first unprovoked seizure?

6 months Signup and view all the answers

What is the goal of epilepsy treatment with anti-seizure medications?

To control seizures and achieve 'no seizures and no side effects' Signup and view all the answers

In the treatment of epilepsy, what is typically the first-line approach for newly diagnosed patients?

Start with one appropriate anti-seizure medication Signup and view all the answers

Surgery for epilepsy may be considered for which of the following?

Patients with seizures that are not controlled by medication (medication-resistant epilepsy) Signup and view all the answers

Which of the following is an alternative treatment for epilepsy, especially for those who cannot control their seizures with medications?

Vagal nerve stimulation or other devices Signup and view all the answers

Which of the following represents a future development in the treatment of epilepsy?

The use of precision medicine, pharmacogenetics, and neurostimulation Signup and view all the answers

What is the most likely cause of epilepsy in a 16-year-old with morning jerks, daydreaming spells, and generalized tonic-clonic (GTC) seizures, given the family history of migraine and alcohol use before seizures?

Genetic cause with generalized epilepsy and myoclonic seizures Signup and view all the answers

In a 29-year-old with febrile seizures as an infant, déjà vu/fear aura followed by lip smacking and generalized tonic-clonic (GTC) seizures from sleep, what is the most likely underlying cause of the epilepsy?

Mesial temporal sclerosis Signup and view all the answers

In a 45-year-old patient with intellectual disability, autism, and episodes of stiffening/incontinence at night along with generalized tonic seizures and atypical absence seizures, what is the most likely cause of the epilepsy?

Genetic mutation (DNM1) Signup and view all the answers

A 6-year-old who frequently zones out during the day, has eye flutter, and activity arrest without significant academic progress, with a diagnosis of typical absence seizures, is most likely to have what type of cause?

Genetic cause of generalized epilepsy Signup and view all the answers