1. medications that may induce epileptiform discharges
    • buproprion
    • cefepime
    • clozapine
    • lithium
    • tramadol
  2. febrile seizures in infant
    • complex if:
    •    focal
    •    last >15 minutes
    •    recurrent within 24 hours
    • febrile seizures occur 6 months - 5 years old
    • rectal diazepam as needed for seizures lasting longer than 5 minutes
    • does increase risk of subsequent epilepsy
    • history of developmental delay increases the risk of future epilepsy
    • >=4 febrile seizures is consistent with increased risk of development of epilepsy
  3. carbamazepine
    autoinduction of its own metabolism
  4. status epilepticus
    midazolam im superior to lorazepam im
  5. contraception for women with epilepsy
    • IUD is preferred
    • enzyme inducing antiseizure medications induce the metabolism of estrogen and progestin; thus more likely failure of contraception
  6. West syndrome
    • infant
    • epileptic spasms
    • hypsarrhthmia on EEG
    • developmental regression
    • do a comparative genomic hybridization array
  7. pyridoxine dependent epilepsy
    serum alpha-aminoadipic semialdehyde level
  8. syncope
    • sudden loss of posture with jerking
    • routine EEG normal
    • loss of postural tone, fall, several seconds of multifocal proximal and distal arrhythmic jerks
    • rapid return to full consciousness
    • EEG - initial theta slowing, then generalized delta, then suppression before return to normal
  9. primary generalized tonic-clonic seizures
    • lamotrigine has efficacy
    • gabapentin, carbamazepine, pregabalin, and oxcarbazepine lack efficacy
  10. highest frequency of anxiety and/or psychosis disorder with epilepsy
    left mesial temporal lobe focus
  11. autoimmune encephalitides
    • first line treatment
    •    corticosteroids
    •    IVIG
    •    plasma exchange
    • second line treatment
    •    cyclophosphamide & rituximab for patients with NMDA receptor encephalitis
  12. Rasmussen encephalitis
    surgical hemispherotomy
  13. definition of epilepsy
    • recurrent unprovoked seizures at least 24 hours apart
    • a single unprovoked seizure with an estimated >60% risk of recurrence
  14. levetiracetam
    binding of synaptic vesicle protein SV2A
  15. sodium channel blockade is anti-seizure mechanism
    • lamotrigine
    • carbamazepine
    • lacosamide
    • oxcarbazepine
    • phyentoin
  16. depression in epilepsy
    • 10-20% in patients with controlled seizures; higher in others
    • SSRI (i.e. sertraline) are first line treatments; few interactions
    • MAO inhibitors and serotonin-norepinephrine reuptake inhibitors are generally safe
    • tricyclics not recommended due to side effects and interactions
    • avoid buproprion
    • ECT can be performed in patients with epilepsy
  17. limbic encephalitis
    • antibodies against the voltage gated potassium channel complex (LGI1 - leucine rich, glioma inactivated antibodies)
    • faciobrachial dystonic seizures - brief tonic contractions of the face and arm and may alternate body sides
    • occur early in limbic encephalitis
    • seizures may be partial, complex, or generalized
    • may occur with autonomic signs or hyponatremia (SIADH)
  18. syncope induced by cough
    EEG shows generalized slowing or suppression
  19. corpus callosotomy
    atonic seizure treatment
  20. most frequent epilepsy related cause of death
    • SUDEP - >20 times sudden death in general population
    • MVA - elevated risk of 2 times population
  21. delta brush EEG pattern
    N-methyl-D-aspartate (NMDA) receptor antibody autoimmune encephalitis
  22. risk of seizure recurrence with development, neurologic exam, MRI, EEG
    • all factors normal - risk is 30-40%
    • all factors abnormal - risk is 90%
  23. infantile spasms in tuberous sclerosis
    vigabatrin is used
  24. seizure with sensation of laryngeal constriction, choking, clouded consciousness, 1-2 minutes, 1-3 times a week
    most likely arise from insula
  25. typical aura, dyscognitive features, orofacial and manual automatisms
    mesial temporal seizure
  26. visual phenomena
    occipital seizure
  27. somatosensory aura and wide variety of ictal manifestations
    parietal seizure
  28. asymmetric tonic posturing
    supplementary sensory motor seizures
  29. centrotemporal spike-and-slow-wave discharges on EEG; frontal dipole
    • benign Rolandic epilepsy
    • hemifacial and motor manifestations
    • occur around sleep onset
    • childhood
  30. anterior dominant generalized 3 Hz spike and slow wave bursts
    absence epilepsy
  31. generalized 1.5 Hz - 2.5 Hz spike and polyspike & slow wave paroxysmal fast activity
    Lennox-Gastaut syndrome
  32. generalized paroxysmal 4 Hz to 6 Hz polyspike and slow wave bursts
    juvenile myoclonic epilepsy
  33. intermittent centroparietal theta rhythm
    • Panayiotopoulus syndrome - a benign focal epilepsy of childhood
    • seizures with prominent autonomic features
    • prolonged seizures
  34. Lennox-Gastaut syndrome continues to have frequent generalized seizures despite adequate trials of several appropriate medications & vagus nerve stimulator installed
    ketogenic diet is next step
  35. corpus callosotomy
    atonic drop attack treatment
  36. highest rate of major congenital malformations
    • valproate
    • 5-14%
    • neural tube defects are the most common
    • also - cardiac defects, clefts, hypospadias
    • exposure to valproate during pregnancy also associated with decrease in IQ and autism
  37. dexamethasone & phenytoin interaction
    reduces serum phenytoin level
  38. pediatric seizure at night
    increases risk of recurrence
  39. febrile seizure - risk of recurrence
    • increased risk of recurrence
    •      young age
    •      low grade fever
    •      family history of febrile seizure
    •      focal seizure more than generalized
    • seizure duration DOES NOT increase risk of recurrence
  40. Dravet syndrome
    • early infant seizures
    • usually febrile
    • hemiconvulsive at first
    • development is normal until seizures start
  41. progressive myoclonic epilepsy
    • progressive decline
    • myoclonic epilepsy
    • ataxia often
  42. a complications of long-term use of phenobarbital
    • decreased bone density
    • Dupuytren contractures
    • plantar fibromatosis
    • joint pain
    • frozen shoulder
    • also, sedation, mood changes, decreased concentration
  43. carbamazepine or oxcarbazepine side effect
  44. gabapentin, pregabalin, valproate side effect
    peripheral edema
  45. valproate side effect
  46. valproate or topiramate
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