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5# Antiepileptic
1. Epilepsy is defined as:
A single unprovoked seizure
Any seizure with fever
A condition with recurrent unprovoked seizures
Abnormal EEG without seizures
Explanation:
Epilepsy is characterized by a predisposition to recurrent unprovoked seizures.
2. Which factor MOST increases the probability of a second seizure after a first isolated seizure?
Normal EEG
Epileptiform abnormalities on EEG
Family history only
Young age
Explanation:
EEG findings with spikes or sharp waves significantly increase recurrence risk.
3. When should antiseizure medications (ASMs) be started?
After every febrile seizure
After one provoked seizure
After head trauma only
After two or more unprovoked seizures
Explanation:
Two or more unprovoked seizures meet diagnostic criteria for epilepsy.
4. Primary goal of antiseizure pharmacotherapy is:
Seizure freedom with minimal adverse effects
Complete cure of epilepsy
EEG normalization
Sedation of the patient
Explanation:
ASMs are symptomatic and aim for seizure control with optimal quality of life.
5. Which seizure type is best treated with ethosuximide?
Focal seizures
Tonic-clonic seizures
Absence seizures
Myoclonic seizures
Explanation:
Ethosuximide is first-line for absence epilepsy.
6. Which ASM is useful for epilepsy AND bipolar disorder?
Ethosuximide
Lamotrigine
Phenobarbital
Gabapentin
Explanation:
Lamotrigine is effective for epilepsy and mood stabilization.
7. In elderly patients, ASM initiation should be:
Rapid with high dose
IV loading only
Avoided
Started low and titrated slowly
Explanation:
Elderly patients are sensitive to sedation, falls, and cognitive impairment.
8. Which situation requires rapid titration or loading dose of ASM?
Multiple recent seizures
Controlled epilepsy
Absence epilepsy
Elderly patient with mild seizures
Explanation:
Frequent recent seizures require faster attainment of therapeutic levels.
9. Which ASM requires slow titration and should NOT be rapidly loaded?
Levetiracetam
Valproate
Lamotrigine
Phenytoin
Explanation:
Rapid titration of lamotrigine increases risk of severe skin rash.
10. Optimal therapeutic dose is achieved when:
Maximum dose is reached
Seizure-free with no adverse effects
EEG becomes normal
Sedation occurs
Explanation:
Goal is seizure freedom at minimal effective dose without side effects.
11. If seizures persist at maximum tolerated dose of one ASM, next step is:
Stop treatment
Increase beyond max dose
Add same-mechanism ASM
Add second ASM with different MOA
Explanation:
Combining drugs with different mechanisms improves efficacy.
12. Ketogenic diet is particularly effective in:
GLUT-1 deficiency epilepsy
Febrile seizures
Post-stroke epilepsy
Psychogenic seizures
Explanation:
Ketogenic diet is effective in refractory epilepsy with GLUT-1 deficiency.
13. Long-term ketogenic diet adverse effect includes:
Hypertension
Hypoglycemia
Kidney stones and bone fractures
Hyperthyroidism
Explanation:
Long-term ketogenic diet increases risk of renal stones and skeletal issues.
14. Vagus nerve stimulation (VNS) is indicated in:
Newly diagnosed epilepsy
Refractory focal seizures
Febrile seizures
Single seizure episodes
Explanation:
VNS is used in drug-resistant focal epilepsy in patients ≥12 years.
15. Epilepsy surgery is most effective in:
Generalized epilepsy
Absence epilepsy
Psychogenic seizures
Refractory focal temporal lobe epilepsy
Explanation:
Surgery is best for focal epilepsy, especially temporal lobe origin.
16. Which factor predicts good surgical outcome?
Focal lesion on MRI
Normal EEG
Long seizure duration
Bilateral abnormalities
Explanation:
Clear focal pathology predicts better surgical success.
17. Dose-related ASM adverse effects are usually:
Life-threatening
CNS-related and reversible
Immune-mediated
Permanent
Explanation:
Sedation, dizziness, and ataxia are dose-dependent and improve with dose adjustment.
18. Which adverse reaction is idiosyncratic?
Sedation
Dizziness
Stevens-Johnson syndrome
Ataxia
Explanation:
Severe skin reactions like SJS/TEN are unpredictable and idiosyncratic.
19. Chronic ASM therapy may cause osteomalacia due to interference with:
Calcium absorption
Parathyroid hormone
Phosphate metabolism
Vitamin D metabolism
Explanation:
Enzyme-inducing ASMs reduce vitamin D levels, causing bone disease.
20. Difference between efficacy and effectiveness of ASMs is that effectiveness:
Accounts for tolerability in real-world use
Is higher than efficacy
Is measured only in trials
Ignores adverse effects
Explanation:
Effectiveness reflects real-world benefit including adherence and side-effects.