2. MTB Step 3 - Seizures

Question 1

DIAGNOSIS

What are (4) Tests that should be done one all patients having a Seizure?

Answer 1

1. Sodium, Calcium, Glucose, Oxygen, Creatinine, and Magnesium levels
2. Head CT urgently; MRI later if the initial testing shows nothing
3. Urine Toxicology screening
4. Liver and Renal function

Question 2

DIAGNOSIS

What should be performed if the initial set of diagnostic tests does not reveal the etiology of the Seizure?

Answer 2

Electroencephalogram (EEG)

Question 3

TREATMENT

What is the ONLY thing that is clear when it comes to Status Epilepticus in Seizure Disorders?

Answer 3

The Management:

• 1st Line: Benzodiazepines, such as Ativan (lorazepam).
• 2nd Line: If the seizure persists after moving the clock forward 10–20 minutes, then add Fosphenytoin.
• 3rd Line: If the seizure persists after moving the clock forward another 10–20 minutes, then add Phenobarbital.
• 4th Line: If the seizure persists after moving the clock forward 10–20 minutes again, then add General Anesthesia, such as Pentobarbital, Thiopental, Midazolam, or Propofol.

Question 4

TREATMENT

Chronic antiepileptic drug therapy is generally not indicated after a single Seizure. What are (4) Exceptions to this (when should you treat chronically after the first seizure)?

Answer 4

1. Strong family history of seizures
2. Abnormal EEG
3. Status Epilepticus that required Benzodiazepines to stop the seizure
4. Non-correctable precipitating cause, (i.e., brain tumor)

Question 5

TREATMENT

What are (5) First-Line therapies for the Long-Term management of Seizures that are all equal in efficacy?

Answer 5

1. Valproic Acid
2. Carbamazepine
3. Phenytoin
4. Levetiracetam (Keppra)
5. Lamotrigine (Lamictal) - has efficacy equal to those agents but is associated with the development of Stevens-Johnson syndrome and severe skin reactions.

Question 6

TREATMENT

What are (4) Second-Line therapies for the Long-Term management of Seizures that are all equal in efficacy?

Answer 6

1. Gabapentin
2. Phenobarbital
3. Lacosamide
4. Zonisamide

Question 7

TREATMENT

What is considered the Best Antiepileptic drug for Absence or Petit Mal Seizures?

Answer 7

Ethosuximide

Question 8

TREATMENT

Which Antiepileptic drug is the Most Dangerous in Pregnancy?

Answer 8

Valproic Acid

Question 9

TREATMENT

Which (2) Antiepileptic drugs are considered the Safest in Pregnancy?

Answer 9

1. Levetiracetam (Keppra)
2. Lamotrigine

Question 10

TREATMENT

Which Antiepileptic drug has the Highest Risk of Hyponatremia?

Answer 10

Carbamazepine

Question 11

TREATMENT

What increases the metabolism of Lamotrigine to ineffective levels?

Answer 11

ESTROGENS

This OCPs

Question 12

TREATMENT

What Test will predict Stevens-Johnson syndrome induced by Carbamazepine and Phenytoin?

Answer 12

HLA B*1502 Testing

Question 13

TREATMENT

What are (2) Disorders that many of the Antiepileptic drugs are associated with?

Answer 13

1. Bone Loss
2. Osteoporosis