Epilepsy

Question 1

What’s a tonic seizure

Answer 1

These seizures manifest with a spasm of the body with stiffened limbs and may even result in backward arching of the back followed by loss of consciousness (STIFFENING)

Question 2

What’s a myoclonic seizure

Answer 2

These manifest as brief jerky movements of the muscles with preserved consciousness

Question 3

What’s a clonic seizure

Answer 3

These are repeated jerky contractions which could have a focal or generalized presentation, depending on how much of the brain surface is involved (JERK)

Question 4

What’s a tonic-clonic seizure?

Answer 4

This is the commonest form of the seizures with a tonic (stiffening) phase followed by a clonic (jerk) phase

Question 5

What’s the commonest form of seizure

Answer 5

Tonic-clonic

Question 6

What are Atonic seizures

Answer 6

These seizures are characterized by a loss of tone of the body with the patient falling to the ground.

Question 7

What’s a hyperkinetic seizure

Answer 7

These are characterized by an agitated movement of a body part like pedaling of the feet

Question 8

Focal seizures that are of impaired awareness, are characterized by what?

Answer 8

Clouding of consciousness, patient can’t remember attack (Amnesia) and automatism.

Question 9

Explain absence seizures

Answer 9

Brief attacks where the patient loses consciousness, they abruptly stop and resume, and have no memory of the attack. Genetic and predominantly in children.

Question 10

What is the most common cause of non epileptic seizures in children

Answer 10

Febrile convulsions

Question 11

Antiepileptic drug for Generalized seizures?

Answer 11

Valproate

Question 12

Antiepileptic drug for Abscence seizures?

Answer 12

Ethosuximide

Question 13

Antiepileptic drug for Focal seizures?

Answer 13

Carbamazepine and phenytoin

Question 14

Valproate and carbamazepine are contraindicated in who and why?

Answer 14

Pregnant women, associated with congenital defects

Question 15

What is Status Epilepticus?

Answer 15

Defined as repeated seizures without regaining consciousness for more than 30 mins OR a single one longer than 5 mins.

Question 16

Status epilepticus causes?

Answer 16

It may result from sudden withdrawal of antiepileptic drugs, non-compliance to treatment or any other cause of seizures

Question 17

First line therapy for Status Epilepticus?

Answer 17

IV Benzos

Question 18

A patient presents with “lightning-like” jerks of the arms upon waking, sometimes leading to a generalized tonic-clonic seizure. Which of the following antiepileptic drugs should be AVOIDED as it may exacerbate this seizure type?
A) Valproate
B) Levetiracetam
C) Phenytoin
D) Clonazepam

Answer 18

Phenytoin

Question 19

Any patient with seizures and a fever requires which investigation?

Answer 19

A lumbar puncture

Question 20

A 7-year-old child has brief episodes of staring and eyelid fluttering lasting 10-15 seconds, during which he is unresponsive. He resumes his previous activity immediately afterward with no memory of the event. The interictal EEG is likely to show which of the following patterns?
a) Focal spike-and-wave discharges in the temporal lobe
b) 3 Hz spike-and-wave discharges
c) Polyspike discharges
d) Hypsarrhythmia

Answer 20

3Hz spike-and-wave discharges

Question 21

. A 25-year-old patient presents with a seizure that began with twitching of his right thumb, which then spread to involve his entire right hand and arm over 30 seconds before he lost consciousness. This progression is most characteristic of:
a) Atonic seizure
b) Jacksonian march seizure
c) Absence seizure
d) Psychogenic non-epileptic seizure

Answer 21

Jacksonian March seizure

Question 22

A patient presents with recurrent episodes characterized by impaired awareness, stereotyped lip-smacking movements, and amnesia for the event. These seizures most commonly originate from which lobe of the brain?
a) Frontal
b) Temporal
c) Parietal
d) Occipital

Answer 22

Temporal

Question 23

Which of the following antiepileptic drugs should be avoided in a patient with myoclonic seizures due to its potential to exacerbate this seizure type?
a) Valproate
b) Levetiracetam
c) Phenytoin
d) Clonazepam

Answer 23

Phenytoin and carbamazepine

Question 24

A 45-year-old man is brought to the emergency department with continuous generalized tonic-clonic seizures for 15 minutes. After securing ABCs (airway, breathing, circulation), what is the most appropriate first-line pharmacological treatment?
a) Intravenous phenytoin
b) Intravenous valproate
c) Intravenous benzodiazepine
d) Intravenous phenobarbita

Answer 24

IV benzos (diazepam or lorazepam)

Question 25

Which of the following is the best initial investigation for a patient with new-onset focal seizures? a) Lumbar puncture b) MRI brain c) Routine EEG d) Serum prolactin level

Answer 25

Brain MRI

Question 26

. A normal interictal EEG occurs in approximately what percentage of patients with epilepsy? a) 10% b) 25% c) 50% d) 90%

Answer 26

50%

Question 27

Which of the following is the drug of choice for absence seizures? a) Phenytoin b) Carbamazepine c) Ethosuximide d) Phenobarbital

Answer 27

Ethosuximide

Question 28

A patient develops status epilepticus that continues despite appropriate doses of benzodiazepines and a second-line antiepileptic drug. This condition is best described as: a) Simple status epilepticus b) Established status epilepticus c) Refractory status epilepticus d) Super-refractory status epilepticus

Answer 28

Refractory status Epilepticus

Question 29

A patient with epilepsy has been seizure-free for 2 years on antiepileptic medication. According to the document, what percentage of such patients will remain seizure-free if medication is discontinued? a) 10% b) 33% c) 66% d) 90%

Answer 29

66%