ABPN Epilepsy and Seizure Disorders Flashcards

Which epilepsy syndrome is characterized by the triad of infantile spasms, hypsarrhythmia on EEG, and developmental regression or arrest?

Answer: West syndrome

West syndrome presents in infancy with the classic triad of epileptic (infantile) spasms, hypsarrhythmic EEG pattern, and psychomotor developmental regression.

For medically refractory temporal lobe epilepsy with MRI evidence of hippocampal sclerosis, which surgical procedure is most commonly performed and has the highest rate of seizure freedom?

Answer: Anterior temporal lobectomy

Anterior temporal lobectomy (ATL) is the most commonly performed epilepsy surgery and yields 60-90% seizure freedom rates in well-selected patients with unilateral hippocampal sclerosis.

What is the most common metabolic cause of neonatal seizures?

Answer: Hypoglycemia

Hypoglycemia is the most common metabolic cause of neonatal seizures and requires prompt glucose correction; other causes include hypocalcemia and hypomagnesemia.

What approximate percentage of patients who experience a single unprovoked seizure will have a recurrence within 2 years?

Answer: 40-50%

Approximately 40-50% of patients have a recurrence after a single unprovoked seizure within 2 years, which informs the decision about whether to initiate antiepileptic therapy.

Psychogenic non-epileptic seizures (PNES) are most definitively diagnosed by which investigation?

Answer: Video-EEG monitoring capturing a typical event

Video-EEG monitoring that captures a typical event with no ictal EEG correlate is the gold standard for diagnosing PNES, demonstrating semiology without epileptiform activity.

A patient with refractory epilepsy is started on the ketogenic diet. Which metabolic change is primarily responsible for the diet's antiseizure mechanism?

Answer: Production of ketone bodies that alter neuronal energy metabolism and neurotransmitter levels

The ketogenic diet shifts brain metabolism to ketone bodies (beta-hydroxybutyrate, acetoacetate), which alter GABA/glutamate balance, mitochondrial function, and ion channel activity to produce antiseizure effects.

Which of the following best describes the mechanism of action of vagus nerve stimulation (VNS) in epilepsy treatment?

Answer: Afferent stimulation of the vagus nerve modulating thalamocortical networks and locus coeruleus noradrenergic pathways

VNS works via afferent vagal fibers projecting to the nucleus tractus solitarius, which in turn modulates thalamocortical circuits and activates noradrenergic projections from the locus coeruleus, reducing seizure susceptibility.