Answer

Epilepsy Quiz Answers

1. B = Facial Angio fibroma

Explanation/Comment: Patient is a suffering from Tuberous Sclerosis, a neuro cutaneous syndrome where epilepsy is the main feature with multisystem involvement.

• 2.– B = Clobazam

Explanation/Comment: A major problem in the management of seizures is that many of the commonly used anticonvulsants can precipitate or worsen acute attacks.

Reference: Deybach JC, Badminton M, Puy H, Sandberg S, Frank J, Harper P, et al. European Porphyria Initiative (EPI): A Platform to Develop a Common Approach to the Management of Porphyrias and to Promote Research in the Field. Physiol. Res. 55 (Suppl. 2): S67–S73, 2006.

• 3.– C = Lamotrigine

Explanation/Comment: The most pronounced decline in serum concentrations is seen for AEDs that are eliminated by glucuronidation (UGT), in particular lamotrigine where the effect may be profound.

Reference: Torbjörn Tomson, Cecilie Johannessen Landmark, Dina Battino. Antiepileptic drug treatment in pregnancy: Changes in drugdisposition and their clinical implications. Epilepsia, 54(3):405–414, 2013. http://dx.doi.org/10.1111/epi.12109.

• 4.– D

Explanation/Comment: Epilepsy is considered to be resolved for individuals who had an age-dependent epilepsy syndrome but are now past the applicable age or those who have remained seizure-free for the last 10 years, with no seizure medicines for the last 5 years.

Reference: Robert S. Fisher, Carlos Acevedo, Alexis Arzimanoglou, Alicia Bogacz, Helen Cross, Christian E. Elger, et al. A practical clinical definition of epilepsy. Epilepsia, 55(4):475–482, 2014. http://dx.doi.org/10.1111/epi.12550.

• 5.– C = Lamotrigine

Explanation/Comment: Gabapentin and Lamotrigine are established level A AED's for elderly.

Reference: Glauser T, Ben-Menachem E, Bourgeois B, Cnaan A, Guerreiro C, Kälviäinen R, et al. for the ILAE subcommission of AED Guidelines. Updated ILAE evidence review of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes. Epilepsia. 2013 Mar;54(3):551–63. http://dx.doi.org/10.1111/epi.12074. Epub 2013 Jan 25.

• 6.– C = CJD

Explanation/Comment: EEG shows typical short-interval periodic sharp wave complexes of Creutzfeldt-Jakob disease (CJD).

Ref: Wieser HG, Schindler K, Zumsteg D. EEG in Creutzfeldt-Jakob disease. Clin Neurophysiol. 2006 May;117(5):935–51. Epub 2006 Jan 25.

• 7.– C Phenytoin

Explanation/Comment: Patients with Stevens–Johnson syndrome and toxic epidermal necrolysis exhibited slower metabolism, or drug clearance; in these patients, there was also a stronger association with the CYP2C.

Ref: Chung WH, Chang WC, Lee YS, et al. Genetic variants associated with phenytoin-related severe cutaneous adverse reactions. JAMA 2014; 312:525–534.

• 8.– A

Explanation/Comment: Pregnant women on AED should undergo a serum alfa fetoprotein and level II ultrasound at 14–18 weeks of gestation to rule out NTD's.

Reference: Jerome Engel Jr, Timothy A. Pedley, Jean Aicardi. Epilepsy: A Comprehensive Textbook. Lippincott Williams & Wilkins, 2008.

• 9.– A = Elementary visual hallucinations of occipital seizures are prolonged, slowly developing and last for hours.

Explanation/Comment: Elementary visual hallucinations of occipital seizures are brief for seconds to 3 minutes; develop fast within seconds to 3 minutes. They usually start in the periphery of a hemifield and often march to other seizure symptoms or convulsions. These features may help guide the clinician.

Reference: Panayiotopoulos CP. Elementary visual hallucinations, blindness and headache in idiopathic occipital epilepsy: Differentiation from migraine. J Neurol Neurosurg Psychiatry. 1999; 66:536–540.

Panayiotopoulos CP. Visual phenomena and headache in occipital epilepsy: A review, a systematic study and differentiation from migraine. Epileptic Disord. 1999; 1:205–216.

• 10.– C = OIRDA

Explanation/Comment: Occipital Intermittent rhythmic delta activity. Intermittent rhythmic delta activity is a typical EEG pattern that was originally described by W.A. Cobb in 1945 (J Neurol Neurosurg Psychiatr 1945;8:65–78). OIRDA) is considered good prognostic factor in typical absences.

Reference: Guilhoto LM, Manreza ML, Yacubian EM. Occipital intermittent rhythmic delta activity in absence epilepsy. Arq Neuropsiquiatr. 2006 Jun; 64(2A):193–7. Epub 2006 Jun 9. Occassionally it may be seen in other conditions too.