Seizure and Epilepsy

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Question 1 of 82

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is a transient occurrence of signs and symptoms due to abnormal excessive or synchronous neuronal activity in the brain

Explanation

Question 2 of 82

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is a neurological disease marked by the sudden and recurrent episodes of seizures

Explanation

Question 3 of 82

A person is considered to have epilepsy if they meet any of the following conditions:

Select one or more of the following:

At least two unprovoked (or reflex) seizures occurring greater than 24 hours apart
One unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next 10 years
Diagnosis of an epilepsy syndrome
Have an single unprovoked seizure event

Explanation

Question 4 of 82

More than 30 minutes of:
- continuous seizure activity
- two or more sequential seizures without full recovery of consciousness between seizures.

Select one of the following:

Seizure
Epilepsy
Status Epilepticus

Explanation

Question 5 of 82

Fill the blank spaces to complete the text.

Some seizures occur as single events
- Withdrawal of depressants
- During acute illnesses
- Systemic conditions
- Cocaine use
- Overdosing on
- disturbances
- Hypoglycemia

Explanation

Question 6 of 82

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Causes of seizures

: stroke, post-stroke, AV malformations
: meningitis, Lyme disease, brain abscess, HIV related
: Brain injury
: SLE
: hypoglycemia, electrolyte disturbances (Na⁺, Ca⁺⁺, Mg⁺⁺)
: versus cryptogenic
: primary brain tumor or metastatic
: Down’s Syndrome
: IV drug use, cocaine, ephedrine, herbal remedies

Explanation

Question 7 of 82

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are also called the electrical storms in the brain

Explanation

Question 8 of 82

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is the main inhibitory neurotransmitter

is the major excitatory neurotransmitter

Explanation

Question 9 of 82

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Every individual has a seizure , which is the level of excitability at which neurons will discharge abnormally

Explanation

Question 10 of 82

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Patients with epilepsy have a seizure threshold

Explanation

Question 11 of 82

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( Prodrome, Aura, Ictal phase, post-ictal phase ) is feelings, sensations, or changes of behavior hours or days before a seizure
- warning that a seizure is coming
- not considered part of the seizure

Explanation

Question 12 of 82

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or warning is the first symptom of a seizure
- Changes in smells, sounds, tastes, vision, “strange” feelings, racing thoughts, fear/panic, headache, nausea, numbness or tingling in part of the body
- Considered part of the seizure

Explanation

Question 13 of 82

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phase is the middle of a seizure
- Correlates with the electrical activity in the brain
- Where the symptoms are observed

Explanation

Question 14 of 82

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phase is the end of a seizure
- Recovery period after the seizure (immediate or can take minutes to hours)

Explanation

Question 15 of 82

Every person with seizures will not have every stage or symptom

Select one of the following:

True
False

Explanation

Question 16 of 82

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seizures start in one area or side of the brain

Explanation

Question 17 of 82

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seizures start on both sides of the brain at the same time and usually loss of consciousness is observed

Explanation

Question 18 of 82

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A partial seizure in which consciousness is not impaired is referred to as a partial seizure

Explanation

Question 19 of 82

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A partial seizure in which consciousness is impaired is referred to as a partial seizure

Explanation

Question 20 of 82

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A partial onset evolving to generalized tonic-clonic is referred to as a seizures

Explanation

Question 21 of 82

Name the type of the seizure:

Generally occurs in young children
Sudden onset, interruption of ongoing activity
Blank stare
Possibly a brief upward rotation of the eyes

Select one of the following:

Absence
Myoclonic
Clonic
Tonic

Explanation

Question 22 of 82

Name the type of seizure:

Brief shock-like muscular contractions of the face, trunk, and extremities

Select one of the following:

Absence
Myoclonic
Clonic
Tonic

Explanation

Question 23 of 82

Name the type of seizure:

Rhythmic, repetitive, jerking muscle movement

Select one of the following:

Absence
Myoclonic
Clonic
Tonic

Explanation

Question 24 of 82

Name the type of seizure:

Flexion, extension, and adduction of extremities
Extension of back and neck
Contraction of thoracic and abdominal muscles (may become apneic)
Upward eye movement and mouth partially open
May cry out as air is forced from the lungs

Select one of the following:

Absence
Myoclonic
Clonic
Tonic

Explanation

Question 25 of 82

Which of the following statements about Atonic seizures are true?

Select one or more of the following:

Sudden loss of muscle tone
common in children
may present with head drop, dropping of a limb, and slumping to the ground
Patients often wear protective headgear to prevent trauma

Explanation

Question 26 of 82

There are NO diagnostic laboratory tests for epilepsy

Select one of the following:

True
False

Explanation

Question 27 of 82

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levels can be transiently elevated after GTC or CP seizures, however this observation can not be used as a diagnostic marker for epilepsy.

Explanation

Question 28 of 82

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( Electroencephalogram (EEG), Magnetic Resonance Imaging (MRI), Computed Tomography (CT) ) is very useful in the diagnosis of various seizure disorders (only to confirm a diagnosis)

Explanation

Question 29 of 82

Which of the following is NOT useful in the diagnosis of seizure disorders?

Select one of the following:

Electroencephalogram (EEG)
Magnetic Resonance Imaging (MRI)
Computed Tomography (CT)

Explanation

Question 30 of 82

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Focal seizures: previously called , these start in an area or network of cells on one side of the brain

Generalized seizures: previously called , these affect both sides of the brain at onset

Unknown onset: is the onset of the seizure is not known

Focal to bilateral seizure: previously called , it starts in one side of the brain and spreads to both sides

Explanation

Question 31 of 82

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Focal aware: replaces the term ; if awareness remains intact even if person is unable to talk or respond during a seizure

Focal impaired awareness: replaces the term seizure; if awareness is impaired or affected at any time during a seizure even if a person has a vague idea of what happened

Awareness unknown: for example if person lives alone or has seizures only at night

Generalized seizures: these are all presumed to affect a person’s awareness or consciousness in some way

Explanation

Question 32 of 82

Which of the following statements are true in regards to febrile seizures?

Select one or more of the following:

Children aged 3 months to 6 years may have tonic-clonic seizures when they have a high fever
More likely to occur if there is a family history of febrile seizures
Most children do not require daily treatment with medications
The outlook is excellent; the majority of children will not have seizures without a fever after the age of 5
Medications can be considered for children who have repeated episodes of multiple febrile seizures

Explanation

Question 33 of 82

Which drugs can be used as prophylaxis in the treatment of febrile seizures?

Select one or more of the following:

Phenobarbital
Valproate
Lamotrigine
Lorazepam

Explanation

Question 34 of 82

What medications can be given at the time of a febrile seizure?

Select one or more of the following:

Diazepam gel or liquid (can be given rectally)
clonazepam (placed on the tongue)
diazepam tablet (crushed and put between the cheek and gum)
lorazepam tablet (crushed and put between the cheek and gum)
can be treated with AED's

Explanation

Question 35 of 82

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Initiation of AEDs is recommended in the following cases:
After one seizure in patients with
After two seizures that occurred within a period of months

Explanation

Question 36 of 82

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Risk factors for seizures (at least one is need to initiate treatment)

- insult (stroke, head trauma, bleeding)
- Family history of
- changes in
- some illness (babies born small for their age, babies who have seizure in the first month of life, babies born with abnormal areas in the brain)
- tumor
- autism
- use of such as cocaine

Explanation

Question 37 of 82

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The probability of a 2nd seizure can be as high as % after 5 years

Explanation

Question 38 of 82

If the probability of a 2nd seizure is less than 10% in the 1st year and 24% after 2 years, you are NOT considered to be at risk and treatment initiation should not begin.

Select one of the following:

True
False

Explanation

Question 39 of 82

A 50 year old male had a documented GTC seizure at 10am this morning. Patient has been recently diagnosed with a brain tumor. What is your recommendation regarding initiating AEDs for this patient?

Select one of the following:

Treatment with anticonvulsants should be initiated
Treatment with anticonvulsants should be deferred at this point

Explanation

Question 40 of 82

Which of the following are triggers for seizures?

Select one or more of the following:

Missed medicine
Lack of sleep
Stress
Alcohol
Drug abuse (amphetamine, stimulant, marijuana, heroin, nicotine, caffeine)
Menstruation (hormonal change, can adjust medication dose in women with regular cycles or prescribe lorazepam (Ativan) for several days around the menstrual cycle
Others (OTC agents such as diphenhydramine, some herbal medicines)

Explanation

Question 41 of 82

Diphenhydramine raises the seizure threshold

Select one of the following:

True
False

Explanation

Question 42 of 82

Which of the following factors must be considered when selecting the appropriate AED therapy for a patient?

Select one or more of the following:

Seizure type
Age
Gender (pregnancy)
Pharmacokinetic profile
Interactions/other medical conditions
Efficacy
Expected adverse effects
Ability to comply with a prescribed regimen
Cost

Explanation

Question 43 of 82

An antiepileptic drug should not be considered ineffective unless patient develops an unacceptable ADR with continued seizure

Select one of the following:

True
False

Explanation

Question 44 of 82

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Despite appropriate initial treatment, ( 30-35, 20-30, 40-50 )% of patients are refractory to treatment

Explanation

Question 45 of 82

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carbamazepine half-life is variable because of which is usually complete 3 to 5 weeks after initiation of a fixed carbamazepine regimen

Explanation

Question 46 of 82

Which of the following agents can cause acute hepatic failure, acute pancreatitis, and alopecia?

Select one of the following:

Phenytoin (Dilantin)
Carbamazepine (Tegretol)
Valproic Acid (Depakote)
Gabapentin (Neurontin)

Explanation

Question 47 of 82

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Serum concentrations are useful when optimizing AED therapy, they should be assessed by:

- Checking "": different for each drug (average 1 to 3 weeks)
- Checking at a time: preferably first thing in the
- Its best to check a level first thing in the morning, hours after the last dose (lowest level)

Explanation

Question 48 of 82

Give the following information, calculate the corrected phenytoin concentration.
(Total phenytoin is 8mcg/mL ; albumin 1mg/dL)

Corrected phenytoin = measured phenytoin / [(0.29 x albumin) + 0.1)

Select one of the following:

Explanation

Question 49 of 82

What is the most common type of seizure experienced by adults?

Select one of the following:

partial seizures
generalized seizures
absence seizures

Explanation

Question 50 of 82

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and phenytoin first line therapy in new-onset partial and generalized seizures

Explanation

Question 51 of 82

Of the agents listed below, which received FDA approval for use as monotherapy in patients with partial seizures?

Select one or more of the following:

Lamotrigine (Lamictal)
Topiramate (Topamax)
Oxcarbazepine (Trileptal)
Levetiracetam (Keppra)
Gabapentin (Neurontin)

Explanation

Question 52 of 82

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( Lamotrigine, Gabapentin, Topiramate ) was determined to be a cost effective alternative to carbamazepine

Explanation

Question 53 of 82

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Indicate the appropirate drug therapy treatment for absence seizures:

1st line: ( Ethosuximide (Zarontin), Valproate (Depakote), Lamotrigine (Lamictal) )
2nd line: ( Valproate (Depakote), Ethosuximide (Zarontin), Lamotrigine (Lamictal) )
3rd line: ( Lamotrigine (Lamictal), Ethosuximide (Zarontin), Valproate (Depakote) )

Explanation

Question 54 of 82

Which of the following agents are infective in absence seizures and can precipitate and increase seizure frequency

Select one or more of the following:

Phenytoin (Dilantin)
Phenobarbital
Carbamazepine (Tegretol)
Oxcarbazepine (Trileptal)
Gabapentin (Neurontin)
Tiagabine (Gabitril)
Valproate (Depakote)

Explanation

Question 55 of 82

What is the appropriate therapy to utilize in the treatment of mixed absence and partial or generalized:

Select one or more of the following:

Valproate (Depakote)
Lamotrigine (Lamictal)
Tiagabine (Gabitril)
Felbamate (Felbatol)

Explanation

Question 56 of 82

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in combination with another AED is a n alternative therapy in the treatment of mixed absence and partial/generalized seizures.

Explanation

Question 57 of 82

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is the traditional treatment for tonic-clonic seizures. and Valproate (Depakote) are equally efficacious and have less side effects.

Explanation

Question 58 of 82

What drugs are alternative in the treatment of tonic-clonic seizures?

Select one or more of the following:

Lamotrigine (Lamictal)
Topiramate (Topamax)
Phenytoin (Dilantin)
Gabapentin (Neurontin)

Explanation

Question 59 of 82

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Seizure freedom for ≥ 2 years implies overall >% chance of successful withdrawal in some epilepsy syndromes

Explanation

Question 60 of 82

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Patients who are seizure free:

years: Absence
years: simple partial, complex partial, tonic-clonic seizures

Explanation

Question 61 of 82

Sudden discontinuation of AED therapy can precipitate withdrawal seizures and status epilepticus. Especially with benzodiazepines and barbiturates

Select one of the following:

True
False

Explanation

Question 62 of 82

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When converting to monotherapy from polytherapy:
Eliminate drugs first
Withdraw antiepileptic agents over several months

Explanation

Question 63 of 82

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AEDs and Pregnancy

- AED teratogenicity is related to exposure in the trimester of pregnancy
- may be deleterious to the fetus
- Risks from seizures are greater than risks from
- All antiepileptic patient drugs carry risks
- Polytherapy of AED's risk
- is encouraged and can be done safely, advise the mother to take the AED immediately after breastfeeding

Explanation

Question 64 of 82

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AEDs and Pregnancy

Before pregnancy:
- Attempt AED monotherapy with effective dose
- supplementation (at least 1mg/day orally)

During pregnancy:
- Avoid use of: Barbiturates, , carbamazepine,
- Limit dose of during the 1st trimester (1,400 mg/day)
- is considered safe
- Continue supplementation (1mg/day)
- Consider (10mg/day) starting at 36 weeks (baby should receive 1 mg IM at birth)

Explanation

Question 65 of 82

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seizures are defined as lasting less than 5 minutes
seizure are defined as lasting between 5 and 30 minutes

Explanation

Question 66 of 82

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Status epilepticus (SE) is defined as more than minutes of either
(1) A seizure activity
(2) Two or more sequential seizures without full recovery of in between seizures

Explanation

Question 67 of 82

The 30-minute definition is based on the duration of convulsive status epilepticus that may lead to permanent neuronal injury. What are some of the adverse consequences?

Select one or more of the following:

hypoxia
acidosis
hyperthermia
hypothermia

Explanation

Question 68 of 82

Types of Status Epilepticus

status epilepticus consisting of repeated generalized tonic-clonic (GTC) seizures with persistent neurological depression of neurologic function between seizures

Select one of the following:

convulsive
non-convulsive
Repeated partial seizures

Explanation

Question 69 of 82

Types of Status Epilepticus

status epilepticus where seizures produce a continuous “ epileptic twilight” state

Select one of the following:

convulsive
non-convulsive
repeated partial seizures

Explanation

Question 70 of 82

Types of Status Epilepticus

manifested as focal motor signs, focal sensory symptoms, or focal impairment of function (e.g. aphasia) not associated with loss of consciousness

Select one of the following:

convulsive
non-convulsive
repeated partial seizures

Explanation

Question 71 of 82

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Causes of Status Epilepticus

; no structural lesion: infection, CNS infection, metabolic, low AED levels, alcohol, idiopathic

; structural lesion (poor prognosis): anoxia/hypoxia, CNS tumors, CVA, drug overdose, hemorrhage, trauma

Explanation

Question 72 of 82

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Clinical Presentation of Generalized Convulsive SE

Symptoms:
Impaired
once is controlled
Pain associated with injuries

Early signs:
Generalized
Acute injuries/CNS insults that cause extensor or flexor posturing
/fever suggestive of inter-current illnesses
Incontinence
Normal blood pressure/hypotension and respiratory

Late signs:
Clinical seizures/may not be apparent
edema with respiratory failure
Cardiac failure, hypotension or hypertension
Disseminated intravascular coagulation, multisystem failure
Rhabdomyolysis

Explanation

Question 73 of 82

Which of the following is the proposed interventions for the treatment of Status epilepticus during the stabilization phase (0-5 minutes) ?

Select one of the following:

Explanation

Question 74 of 82

Which of the following is the proposed interventions for the treatment of Status epilepticus during the initial therapy phase (5-20 minutes) ?

Select one of the following:

Explanation

Question 75 of 82

Which of the following is the proposed interventions for the treatment of Status epilepticus during the second therapy phase (20-40 minutes) ?

Select one of the following:

Explanation

Question 76 of 82

Which of the following is the proposed interventions for the treatment of Status epilepticus during the third therapy phase (40-60 minutes) ?

Select one of the following:

Explanation

Question 77 of 82

Of the two major ingredients in marijuana, which one causes the psychoactive effect of getting "high"

Select one of the following:

Tetrahydrocannabinol (or THC)
Cannabidiol (or CBD)

Explanation

Question 78 of 82

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Medical Marijuana and Epilepsy

Currently open-labeled studies in the U.S. of produced by GW Pharmaceuticals, a drug derived from CBD (99% oil-based extract)

Explanation

Question 79 of 82

Which of the following are non-pharmacologic treatment of seizures and epilepsy?

Select one or more of the following:

Lifestyle modifications (adequate sleep, avoid alcohol & stimulants), avoid precipitants, use stress reduction techniques)
Ketogenic diet ( high in fats, low in proteins and carbs)
vagal nerve stimulation
surgery

Explanation

Question 80 of 82

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Ketogenic Diet

Traditionally started gradually in the hospital after a hour fast

Ratio (fat: carbs and proteins)
- more strict
- for infants, adolescents
- Vitamins and minerals are supplemented

Side effects: due to large amount of fat consumption
-Constipation
-Weight
- when ill
- deficiency (if unsupplemented)
- stones
- Impaired weight and height
- Dyslipidemia
- Gastrointestinal upset

Requires strict control and patient compliance

Explanation

Question 81 of 82

Which of the following statements are true in regards to Vagal Nerve stimulation?

Select one or more of the following:

Intermittent programmed electrical stimulation of left vagus nerve
FDA approved for partial onset seizures in patients >12 years old refractory to AEDs
Implanted Medical Device
Adverse effects local, related to stimulus (hoarseness, throat discomfort, dyspnea, cough, voice alteration)
May allow antiepileptic drug reduction (dose or number)

Explanation

Question 82 of 82

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National Institute of Health Consensus Conference:

3 requirements for surgery:
(1) Absolute diagnosis of
(2) on adequate trial of drug therapy
(3) Definition of the electro clinical syndrome

Explanation

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	Created by Mark W. over 9 years ago

NAPLEX Pharmacy (Neuro ) Quiz on Seizure and Epilepsy , created by Mark W. on 01/10/2017.

Seizure and Epilepsy

Question 1 of 82

Fill the blank space to complete the text.

is a transient occurrence of signs and symptoms due to abnormal excessive or synchronous neuronal activity in the brain

Explanation

Question 2 of 82

Fill the blank space to complete the text.

is a neurological disease marked by the sudden and recurrent episodes of seizures

Explanation

Question 3 of 82

A person is considered to have epilepsy if they meet any of the following conditions:

Select one or more of the following:

Explanation

Question 4 of 82

More than 30 minutes of: - continuous seizure activity - two or more sequential seizures without full recovery of consciousness between seizures.

Select one of the following:

Explanation

Question 5 of 82

Fill the blank spaces to complete the text.

Some seizures occur as single events - Withdrawal of depressants - During acute illnesses - Systemic conditions - Cocaine use - Overdosing on - disturbances - Hypoglycemia

Explanation

Question 6 of 82

Fill the blank spaces to complete the text.

Explanation

Question 7 of 82

Fill the blank space to complete the text.

are also called the electrical storms in the brain

Explanation

Question 8 of 82

Fill the blank spaces to complete the text.

is the main inhibitory neurotransmitter is the major excitatory neurotransmitter

Explanation

Question 9 of 82

Fill the blank space to complete the text.

Every individual has a seizure , which is the level of excitability at which neurons will discharge abnormally

Explanation

Question 10 of 82

Fill the blank space to complete the text.

Patients with epilepsy have a seizure threshold

Explanation

Question 11 of 82

Select from the dropdown list to complete the text.

Prodrome Aura Ictal phase post-ictal phase( Prodrome, Aura, Ictal phase, post-ictal phase ) is feelings, sensations, or changes of behavior hours or days before a seizure - warning that a seizure is coming - not considered part of the seizure

Explanation

Question 12 of 82

Fill the blank space to complete the text.

or warning is the first symptom of a seizure - Changes in smells, sounds, tastes, vision, “strange” feelings, racing thoughts, fear/panic, headache, nausea, numbness or tingling in part of the body - Considered part of the seizure

Explanation

Question 13 of 82

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phase is the middle of a seizure - Correlates with the electrical activity in the brain - Where the symptoms are observed

Explanation

Question 14 of 82

Fill the blank space to complete the text.

phase is the end of a seizure - Recovery period after the seizure (immediate or can take minutes to hours)

Explanation

Question 15 of 82

Every person with seizures will not have every stage or symptom

Select one of the following:

Explanation

Question 16 of 82

Fill the blank space to complete the text.

seizures start in one area or side of the brain

Explanation

Question 17 of 82

Fill the blank space to complete the text.

seizures start on both sides of the brain at the same time and usually loss of consciousness is observed

Explanation

Question 18 of 82

Fill the blank space to complete the text.

A partial seizure in which consciousness is not impaired is referred to as a partial seizure

Explanation

Question 19 of 82

Fill the blank space to complete the text.

A partial seizure in which consciousness is impaired is referred to as a partial seizure

Explanation

Question 20 of 82

Fill the blank space to complete the text.

A partial onset evolving to generalized tonic-clonic is referred to as a seizures

More than 30 minutes of:
- continuous seizure activity
- two or more sequential seizures without full recovery of consciousness between seizures.

Some seizures occur as single events
- Withdrawal of depressants
- During acute illnesses
- Systemic conditions
- Cocaine use
- Overdosing on
- disturbances
- Hypoglycemia

is the main inhibitory neurotransmitter

is the major excitatory neurotransmitter

( Prodrome, Aura, Ictal phase, post-ictal phase ) is feelings, sensations, or changes of behavior hours or days before a seizure
- warning that a seizure is coming
- not considered part of the seizure

or warning is the first symptom of a seizure
- Changes in smells, sounds, tastes, vision, “strange” feelings, racing thoughts, fear/panic, headache, nausea, numbness or tingling in part of the body
- Considered part of the seizure

phase is the middle of a seizure
- Correlates with the electrical activity in the brain
- Where the symptoms are observed

phase is the end of a seizure
- Recovery period after the seizure (immediate or can take minutes to hours)

Name the type of the seizure:

Generally occurs in young children
Sudden onset, interruption of ongoing activity
Blank stare
Possibly a brief upward rotation of the eyes

Name the type of seizure:

Brief shock-like muscular contractions of the face, trunk, and extremities

Name the type of seizure:

Rhythmic, repetitive, jerking muscle movement

Name the type of seizure:

Flexion, extension, and adduction of extremities
Extension of back and neck
Contraction of thoracic and abdominal muscles (may become apneic)
Upward eye movement and mouth partially open
May cry out as air is forced from the lungs

( Electroencephalogram (EEG), Magnetic Resonance Imaging (MRI), Computed Tomography (CT) ) is very useful in the diagnosis of various seizure disorders (only to confirm a diagnosis)

Initiation of AEDs is recommended in the following cases:
After one seizure in patients with
After two seizures that occurred within a period of months