- Which of the following statements regarding the non-epileptic seizures and imitators of epileptic seizures is NOT correct
- Diagnosis of psychogenic seizures is best established by recording typical attacks with video-EEG, although limitations of this technique must be kept in mind.
- Preserved consciousness with bilateral tonic or clonic movements, side-to-side roling, pelvic-thrusting are diagnostic of psychogenic seizures.
- Psychogenic seizures do not respond to antiepileptic drugs as well as epileptic seizures.
- 10-40% of patients with psychogenic seizures also have epilepsy.
- Auras are
- Simple partial seizures.
- Complex partial seizures.
- Generalized seizures.
- Not seizures.
The EEG pattern shown above is most consistent with- generalized tonic-clonic seizures.
- complex partial seizures.
- Typical Absence seizures.
- Stage II sleep.
- The cumulative lifetime incidence of epilepsy is
- 0.03%
- 3%
- 13%
- 30%
- An absence seizure is a type of
- simple partial seizure
- complex partial seizures
- secondarily generalized seizures
- primary generalized seizures
- A 17 year old girl has a seizure that begins with focal rhythmic twitching in her right cheek. The twitching spreads to involve her right thumb and fingers. Occasionally, she may develop rhythmic jerking of her arm. She has not lost awareness with any of the seizures. Her seizures would be classified as:
- simple partial seizure
- complex partial seizures
- secondarily generalized seizure
- primary generalized seizure
- Regarding evaluation after the first seizure, which of the following statements is INCORRECT
- Patients who have had a new-onset seizure should undergo an EEG and, with certain definable exceptions, neuroimaging.
- Bites on the side of the tongue or cheek, and urinary and/or fecal incontinence, are more common after seizures than after loss of consciousness from other causes.
- A normal EEG excludes the diagnosis of epilepsy.
- Lumbar puncture is essential if there is any suspicion of CNS infection.
- Which of the following statements about Benign partial Epilepsy with Centrotemporal Spikes (BECTS) is NOT correct
- It is the most common epilepsy syndrome in childhood.
- Upto 25% of patients develop secondarily generalized seizures.
- Centrotemporal spikes are the electrographic hallmark of the syndrome and indicate focal seizure origin from perirolandic cortex.
- It is usually a lifelong condition.
- Which of the following seizures are often provoked by hyperventilation, an effective means of reproducing seizures in the office or during the EEG?
- absence seizures
- simple partial seizure
- complex partial seizures
- generalized tonic-clonic seizures
- Which of the following statements regarding the management of pediatric epilepsy is NOT correct
- Which of the following statements regarding the management of pediatric epilepsy is NOT correct
- The long-term prognosis of refractory epilepsy is good and often does not affect normal adult functioning.
- Administration of AEDs while feeding should be avoided in the infant and young child.
- Earlier seizure alleviation contributes to a greater reduction in psychosocial morbidity and improved quality of life.
- Which of the following best characterizes typical childhood absence seizures?
- Brief (5-30 seconds), staring, provoked by photic stimulation, with a 10-15 minutes period of post-ictal confusion.
- Brief (5-30 seconds), staring, provoked by hyperventilation, without a significant post-ictal period.
- Brief (5-30 seconds), clusters of rhythmic jerks of the limbs, provoked by sleep deprivation, without a significant post-ictal period.
- Medium duration (1-3 minutes), staring, with prominent automatisms, provoked by stress, with a 10-15 minutes period of post-ictal confusion.
- The term “generalized tonic-clonic seizure” refers to:
- Any type of seizure with jerking and loss of awareness
- A seizure with side-to-side head turning, pelvic thrusting, with eyes closed, and alternating right-left-right arm movements.
- A seizure that involves generalized stiffening, followed by rhythmic jerking of the extremities.
- Any seizure with tongue-biting.
- Which of the following would be most appropriate for the initial evaluation and management of a 6 year old child after a first uncomplicated, unprovoked seizure, if the child is now awake and interacting?
- Detailed history; physical and neurological examination; blood work (electrolytes, glucose, calcium, magnesium, phosphate, tox screen); electroencephalogram; imaging study (CT or MRI). If all are normal, do not start medicine.
- IV load with phenytoin, refer for epilepsy surgery
- Start phenytoin and valproate (to cover focal and generalized seizures). Only obtain EEG and imaging if seizures are not controlled with 2-3 medicines.
- Refer to psychiatry. Most children who present with seizures at this age are malingering.
- Complex partial seizures are generally characterized by
- Sudden onset loss of awareness and lack of post-ictal confusion.
- Aura, altered awareness, staring, automatisms and post-ictal confusion.
- Sudden onset loss of consciousness with convulsive activity.
- Brief myoclonic jerking with intact awareness.
- Which of the following sholud be avoided in the first aid for generalized tonic-clonic seizures?
- Turn patient on his side with head inclined towards ground.
- Do not restrain patient after seizure unless needed to prevent imminent injury.
- Put a rigid object in the patient’s mouth or hold the tongue.
- If multiple seizures occur or a seizure lasts longer than 5 minutes, treatment for status epilepticus should be started.
- Acute seizures can be precipitated by the following factors
- Metabolic and electrolyte imbalance.
- Withdrawal from alcohol or other sedative agents.
- Administration of central nervous system stimulants e.g. cocaine.
- All of above.
- Depression is a common comorbidity in patients with epilepsy but what FDA approved treatment for depression does not increase the risk of seizures?
- Tricyclic antideprssant (TCA) e.g. amitriptyline
- serotonin reuptake inhibitors (SSRI) e.g. paroxtine
- Vagus Nerve Stimulator (VNS)
- Monoamine oxidase inhibitor (MAOI) e.g. bupropion
- A new onset epilepsy patient of Chinese descent is seen. Which medication requires special genetic testing before initiating therapy.
- Levetiracetam
- Carbamazepine
- Topiramate
- Valproic Acid
- Which statement is correct regarding pregnancy and women with epilepsy?
- Pre-term labor and spontaneous abortion are more common among women with epilepsy
- Anti-epileptic medication teratogenicity is associated with drug exposure during the third trimester.
- Prenatal diagnosis of anti-epileptic related malformations is not possible.
- Pregnancy registries have shown that major malformation risk is below 3% for all anti-epileptic drugs
- Which of the following statements is correct regarding pregnancy and epilepsy
- A majority of women will have improved seizure control during pregnancy.
- Most of the women can come off seizure medications during pregnancy.
- A major concern of women of childbearing age is the teratogenic potential of AEDs.
- Folate administration during pregnancy can increase the risk of teratogenic defects.
- Which of the following statements about childhood absence epilepsy is NOT correct
- It is one kind of idiopathic generalized epilepsy syndrome.
- It typically begins at ages 4-14 years.
- EEG is characterized by 1.5-2 Hz spike-wave complexes.
- It responds well to antiepileptic drug (AED) treatment.
The lesion seen in this image is most consistent with- Cortical dysplasia
- Glioblastoma multiforme
- Mesial temporal sclerosis
- Tuberosis sclerosis
- Which statement is correct regarding sudden unexplained death in epilepsy (SUDEP)?
- SUDEP occurs primarily in elderly patient with epilepsy
- Observations suggest that a respiratory mechanism of death is unlikely.
- The risk for persons with intractable epilepsy referred for epilepsy surgery is about 1 person per 100 per year.
- SUDEP is more common among persons with infrequent anti-epileptic medication changes.
- Which feature is more common in epileptic than non-epileptic events?
- Eye closure
- Pelvic thrusting
- Prolonged seizure duration greater than 4 minutes
- Lip smacking