How to Treat: Epilepsy - assessment answers

1. Which TWO of the following are included in the International League Against Epilepsy’s definition of epilepsy?
b. at least two unprovoked (or reflex) epileptic seizures occurring more than 24 hours apart
e. one unprovoked (or reflex) epileptic seizure with a high probability of experiencing a second seizure (>60%)

2. Which TWO of the following terms are no longer used by the International League Against Epilepsy for classification of epileptic seizure types?
d. partial complex seizure
e. secondarily generalised seizure

3. Alan visits you after he lost consciousness while shopping earlier that day, while with his partner. She says the 34-year-old had twitching of both legs (and possibly arms) and his head was “hitting the ground”. It all lasted for about 15 seconds, after which he took a minute or two to return to full consciousness. This is the first time this has happened. Which of the following diagnoses is the most likely?
b. convulsive syncope

4. Belinda crashed her car after she lost consciousness on a long drive home one Sunday afternoon after visiting friends. The 19-year-old escaped with minor injuries, passed an alcohol breath test and no one else was hurt. Witnesses state the car left the straight, level highway and slipped into a ditch, having already slowed somewhat. What is the most likely cause of the accident?
a. driver fatigue

5. Which of the following tests used to investigate epileptic disorders is often performed after sleep deprivation to increase the likelihood of finding diagnostic abnormalities?
c. electroencephalogram

6. Which of the following anti-seizure medications is the best tolerated first-line choice for focal-onset epilepsy?
b. lamotrigine

7. Holly is a 28-year-old woman who has generalised epilepsy with tonic-clonic seizures. Which TWO of the following anti-seizure medications would be the most appropriate to consider as first-line therapy for her?
b. lamotrigine
c. levetiracetam

8. Holly, the 28-year-old patient with generalised tonic-clonic seizures, is started on lamotrigine. What THREE pieces of advice should she be given regarding contraception and pregnancy?
a. if she plans a pregnancy, she should see a neurologist six to 12 months before discontinuing contraception
b. lamotrigine dose and blood levels must be closely monitored if she becomes pregnant
e. depot medroxyprogesterone acetate injections or an intrauterine device (plus condoms) would be better options than oral contraceptives as they do not affect lamotrigine levels

9. All anti-seizure medications are associated with behavioural side effects. Which TWO of the following drugs have the highest risk of significant psychiatric adverse effects, including depression?
c. levetiracetam
e. topiramate

10. Driving is a difficult aspect of epilepsy management. Chris is 23 years old and has had two seizures this week after being seizure free for three years on medication, which he takes reliably and regularly. He has been under work stress and had poor sleep starting a month ago, but he is now sleeping better. Which TWO options are possible stand-down periods from driving that are applicable to Chris?
c. <12 months if a positive neurologist recommendation is obtained
d. 12 months, as laid out in NZ Transport Agency regulations for anyone experiencing a seizure

11. Preventable injuries and deaths during seizures are not uncommon. What is the most common cause of death brought about by seizures?
b. drowning

12. Sudden unexpected death in epilepsy is rare, but it is a concern for patients and families. Which THREE of the following are risk factors for SUDEP?
b. nocturnal seizures
d. tonic-clonic seizures
f. uncontrolled epilepsy