Clin Med Exam 5

Transient disturbance of cerebral function due to abnormal paroxysmal neuronal discharge

What causes a seizure?

Acute symptomatic (provoked) seizure

What type of seizure is caused by a transient brain insult that resolves when the underlying problem is corrected?

Epilepsy

What is defined as recurrent, unprovoked afebrile seizures?

Acute stroke

What is the most common cause of acute symptomatic seizures in older adults?

EEG (electroencephalogram)

What test records electrical activity of the brain and helps classify seizures?

ILAE seizure classification

What classification system categorizes seizures by site of onset, consciousness, and seizure features?

Focal seizure

What seizure begins in one area of the brain?

Generalized seizure

What seizure begins simultaneously throughout both cerebral hemispheres?

Unknown onset seizure

What seizure type is used when the onset cannot be determined?

Focal seizures

What is the most common seizure type in adults?

Medial temporal lobe

What is the most common location of focal seizures?

Hippocampal sclerosis (medial temporal sclerosis)

What structural abnormality is commonly associated with focal temporal lobe epilepsy?

Focal aware seizure

What focal seizure occurs without impairment of consciousness?

Focal impaired awareness (consciousness) seizure

What focal seizure causes impaired responsiveness and inability to recall events?

Focal to bilateral tonic-clonic seizure

What occurs when focal seizure activity spreads throughout the cortex?

Motor cortex involvement

What causes unilateral jerking of the face or extremities during a focal seizure?

Primary sensory cortex

What cortical location causes contralateral tingling during a focal seizure?

Piriform cortex

What cortical location produces hallucinations of unpleasant smells?

Primary auditory cortex

What cortical location produces auditory hallucinations?

Visual cortex

What cortical location produces visual hallucinations or flashing lights?

Temporal lobe epilepsy

What seizure disorder commonly causes déjà vu or jamais vu?

Aura

What is the focal seizure experience that precedes a generalized seizure?

Todd paralysis

What is transient post-seizure weakness of the involved body part?

Postictal state

What period is characterized by confusion, sleepiness, agitation, or amnesia following a seizure?

Absence seizure

Which generalized seizure presents as sudden behavioral arrest and staring?

Myoclonic seizure

Which generalized seizure produces brief, symmetric muscle jerks?

Clonic seizure

Which generalized seizure consists of rhythmic bilateral jerking?

Tonic seizure

Which generalized seizure consists of sustained stiffening?

Tonic-clonic seizure

Which generalized seizure consists of tonic stiffening followed by clonic jerking?

Atonic seizure

Which generalized seizure causes sudden loss of muscle tone ("drop attack")?

Childhood absence epilepsy

Which epilepsy syndrome presents between ages 2-12 with frequent absence seizures?

3-Hz generalized spike-and-wave EEG

What EEG finding is classic for childhood absence epilepsy?

Valproate (Depakote)

What is the first-line medication listed in this lecture for childhood absence epilepsy?

Juvenile myoclonic epilepsy

Which epilepsy syndrome begins in adolescence with myoclonic jerks upon awakening?

Morning myoclonic jerks

What classic symptom is seen in juvenile myoclonic epilepsy?

Febrile seizure

What seizure occurs with fever in children without CNS infection?

Simple febrile seizure

What febrile seizure is generalized, lasts <15 minutes, and occurs only once in 24 hours?

Complex febrile seizure

What febrile seizure has focal onset, lasts >15 minutes, or recurs within 24 hours?

6 months-6 years

What is the typical age range for febrile seizures?

12-24 months

At what age are febrile seizures most common?

Meningitis or encephalitis

What diagnosis must always be considered in a child with a febrile seizure?

Lumbar puncture

What test is indicated for febrile seizures with meningeal signs?

MRI

What imaging is indicated for complex febrile seizures or abnormal neurologic examination?

EEG within 72 hours

When is EEG most useful after a complex febrile seizure?

IV benzodiazepines

What is first-line treatment for a febrile seizure lasting >5 minutes?

Status epilepticus

What seizure emergency is defined as continuous seizure activity lasting ≥5 minutes or recurrent seizures without recovery?

ABCs

What is the first priority in management of status epilepticus?

Lorazepam IV

What is the preferred first-line medication for status epilepticus?

Midazolam IM

What medication is recommended if no IV access is available during status epilepticus?

Fosphenytoin, valproate, or levetiracetam

Which medications are loaded after benzodiazepines in status epilepticus?

Continuous EEG monitoring

What monitoring is required for refractory status epilepticus?

Midazolam, propofol, or pentobarbital infusion

What continuous infusions are used for refractory status epilepticus?

Tongue biting

What historical finding is highly specific for a true seizure?

Urinary incontinence

What clinical finding has poor specificity for distinguishing seizures?

Syncope

What is the most common condition in the differential diagnosis of seizures?

Psychogenic nonepileptic seizure

What seizure mimic is not caused by epileptic neuronal activity?

ECG

What diagnostic test should be obtained in every first seizure evaluation to exclude cardiogenic syncope?

MRI brain

What imaging study is preferred for evaluation of a first unprovoked seizure?

CBC, CMP, glucose, toxicology screen, UA, pregnancy test

What routine laboratory studies are recommended in evaluation of a first seizure?

Lumbar puncture

What additional diagnostic test is indicated if CNS infection is suspected?

EEG

What study often demonstrates epileptiform abnormalities between seizures?

Epileptiform EEG abnormalities

What finding supports starting antiseizure medication after a first seizure?

Structural brain lesion on MRI

What imaging finding supports starting antiseizure medication after a first seizure?

Second unprovoked seizure

After what event should long-term antiseizure medication generally be started?

Acute symptomatic seizure

Which seizure type has a lower long-term risk of epilepsy than an unprovoked seizure?

Antiseizure medication (AED/ASM)

What is another name for anticonvulsant therapy?

Monotherapy

What is the preferred initial strategy for antiseizure medication management?

Stevens-Johnson syndrome

What rare but life-threatening dermatologic adverse effect is associated with many AEDs?

Suicidal ideation

What psychiatric adverse effect is associated with all AEDs?

Decreased bone density

What long-term adverse effect is associated with many AEDs?

Teratogenicity

What pregnancy-related risk is associated with many AEDs?

Lamotrigine

What AED is commonly used for focal seizures and generalized tonic-clonic seizures?

Levetiracetam

What broad-spectrum AED is commonly used for focal, generalized tonic-clonic, and myoclonic seizures?

Oxcarbazepine

What AED is commonly used for focal seizures?

Carbamazepine

What AED is commonly used for focal seizures and focal motor seizures?

Ethosuximide

What AED is classically used for absence seizures?

Valproate

What broad-spectrum AED treats absence, generalized tonic-clonic, myoclonic, and tonic/atonic seizures?

Topiramate

What broad-spectrum AED is used for generalized tonic-clonic seizures?

Zonisamide

What AED may be used for generalized tonic-clonic, myoclonic, and tonic/atonic seizures?

Ketogenic diet

What dietary therapy can reduce seizure frequency in refractory epilepsy?

Vagus nerve stimulation

What implanted therapy desynchronizes cortical electrical activity in refractory epilepsy?

Epilepsy surgery

What definitive treatment may be considered for drug-resistant focal epilepsy?

Sleep deprivation

What common trigger increases seizure risk?

Fever

What physiologic stressor commonly increases seizure risk?

Emotional stress

What psychological factor commonly increases seizure risk?

Never abruptly stop AEDs

What important counseling point should all patients taking antiseizure medications receive?

Steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT)

What is another name for Hashimoto encephalopathy?

Autoimmune process associated with Hashimoto thyroiditis

What is the etiology of Hashimoto encephalopathy?

Acute or subacute onset

How does Hashimoto encephalopathy typically present temporally?

Confusion and altered mental status

What are the hallmark clinical features of Hashimoto encephalopathy?

Seizures

What neurologic manifestation may occur in Hashimoto encephalopathy?

Tremor

What movement disorder may occur in Hashimoto encephalopathy?

Myoclonus

What involuntary movement may occur in Hashimoto encephalopathy?

Psychosis

What psychiatric manifestation may occur in Hashimoto encephalopathy?

Stroke, Creutzfeldt-Jakob disease, and dementia

What disorders can Hashimoto encephalopathy mimic?

Elevated thyroid antibodies

What laboratory finding supports the diagnosis of Hashimoto encephalopathy?

Diagnosis of exclusion using LP, EEG, MRI, and routine delirium evaluation

How is Hashimoto encephalopathy diagnosed?

Corticosteroids

What is the primary treatment for Hashimoto encephalopathy?

Treat underlying thyroid dysfunction if present

What additional treatment should be provided for Hashimoto encephalopathy?

Thiamine (vitamin B1) deficiency

What is the etiology of Wernicke-Korsakoff syndrome?