Seizure Disorders and Epilepsy — MCQs
Which of the following is true about febrile convulsions?
Which condition is associated with periodic discharges on EEG at 4-second intervals?
Todd's palsy can occur after episode of
Adrenocorticotropic hormone is the drug of choice in which of the following conditions?
Child was seen taking off clothes while watching TV; he suddenly closed eyes for some time and was lethargic after some time. He had probably
Which is not used in status epilepticus?
Statement 1 - A 59-year-old patient presents with flaccid bullae. Histopathology shows a suprabasal acantholytic split. Statement 2 - The row of tombstones appearance is diagnostic of Pemphigus vulgaris.
Febrile seizure is called as 'complex' when it lasts for?
The percentage of children with simple febrile seizures who develop epilepsy is:
Which one of the following childhood epileptic disorders often needs long term treatment with antiepileptic drugs?
Seizure Disorders and Epilepsy Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following is true about febrile convulsions?
- A. Recurrent in nature
- B. Occurs at 6 years onwards
- C. No spontaneous remission
- D. Follows high temperature (Correct Answer)
Explanation: ***Follows high temperature*** - Febrile convulsions are **directly associated with fever** and occur during febrile illness, typically when body temperature rises above **38°C (100.4°F)**. - By definition, a febrile seizure occurs in children aged **6 months to 5 years** during a **febrile illness** in the absence of CNS infection or other defined cause. - The seizure may occur during the **rising phase of fever** or when the temperature is already elevated, making this statement the most accurate characterization. *Recurrent in nature* - While febrile convulsions CAN recur, only approximately **30-40% of children** experience recurrent episodes. - The **majority (60-70%)** of children have only a **single episode**, so stating they are "recurrent in nature" is inaccurate. - Risk factors for recurrence include: young age at first episode, family history, and brief duration between fever onset and seizure. *No spontaneous remission* - This is incorrect; febrile convulsions have **excellent prognosis** with spontaneous resolution. - Individual episodes typically last only **a few minutes** and resolve spontaneously without intervention. - The condition itself remits as children grow older, with febrile seizures becoming **rare after age 5-6 years**. *Occurs at 6 years onwards* - This is incorrect; febrile convulsions occur in children between **6 months and 5 years of age**, with peak incidence around **18 months**. - Febrile seizures are **rare after age 6 years**, and a new-onset seizure with fever in an older child warrants investigation for other causes such as CNS infection or epilepsy.
Question 2: Which condition is associated with periodic discharges on EEG at 4-second intervals?
- A. SSPE (Correct Answer)
- B. Absence Seizure
- C. REM sleep disorder
- D. Focal epilepsy
Explanation: ***SSPE*** - **Subacute sclerosing panencephalitis (SSPE)** is a rare, fatal, progressive brain disorder characterized by inflammation and degeneration of the brain. - The distinctive EEG pattern consists of **periodic high-amplitude, slow-wave complexes** that recur every 4-15 seconds, often every 4-8 seconds, making 4-second intervals a key indicator. *Absence Seizure* - Absence seizures typically manifest as **brief staring spells** with impaired consciousness, lasting only a few seconds. - The EEG in absence seizures shows characteristic **generalized 3-Hz spike-and-wave discharges**, not 4-second interval periodic discharges. *REM sleep disorder* - **REM sleep behavior disorder** involves the acting out of vivid dreams due to the absence of normal muscle atonia during REM sleep [1]. - EEG in REM sleep behavior disorder shows normal sleep architecture but may include evidence of **muscle activity (EMG)** during REM sleep, not periodic discharges [1]. *Focal epilepsy* - **Focal epilepsy** originates in a specific area of the brain, causing seizures with symptoms dependent on the affected region [2]. - EEG findings in focal epilepsy typically show **interictal spikes or sharp waves** localized to the region of seizure onset, which are distinct from generalized periodic discharges [2].
Question 3: Todd's palsy can occur after episode of
- A. Generalised tonic clonic seizures
- B. Myoclonic seizures
- C. Atonic seizures
- D. Focal motor seizures (Correct Answer)
Explanation: ***Focal motor seizures*** - **Todd's palsy** is a localized **postictal paresis** or paralysis that occurs after a focal seizure, especially **focal motor seizures** [1]. - It results from **neuronal exhaustion** in the seizure focus, leading to a temporary loss of function in the affected body part. *Generalised tonic clonic seizures* - While generalized tonic-clonic seizures can be followed by a postictal state, **Todd's palsy** is specifically associated with **focal onset seizures** [1]. - The diffuse nature of generalized seizures typically leads to global postictal confusion and fatigue rather than localized weakness [3]. *Myoclonic seizures* - Myoclonic seizures are characterized by **brief, shock-like jerks** and usually do not cause postictal weakness as they involve very short bursts of muscle activity [2]. - They are typically too brief and diffuse to induce the focal, prolonged neuronal exhaustion that leads to Todd's palsy. *Atonic seizures* - Atonic seizures cause a sudden loss of muscle tone, leading to falls, but they do not typically result in **postictal focal paralysis** like Todd's palsy [2]. - The brief, generalized loss of tone is not followed by a specific, localized neurological deficit.
Question 4: Adrenocorticotropic hormone is the drug of choice in which of the following conditions?
- A. West syndrome (Correct Answer)
- B. Juvenile myoclonic epilepsy
- C. Rolandic epilepsy
- D. Lennox Gastaut syndrome
Explanation: ***West syndrome*** - **Adrenocorticotropic hormone (ACTH)** is considered the drug of choice for West syndrome, also known as infantile spasms, due to its efficacy in reducing spasm frequency and improving neurodevelopmental outcomes. - **Steroid therapy**, including ACTH, is thought to work by modulating cortisol levels and neurotransmitter activity, suppressing the abnormal brain activity characteristic of these seizures. *Juvenile myoclonic epilepsy* - The drug of choice for juvenile myoclonic epilepsy is typically **valproate**, or newer antiepileptic drugs like levetiracetam or lamotrigine, known for their efficacy against myoclonic seizures. - ACTH is not used in this condition, as it is generally effective for specific types of **epileptic encephalopathies** and not generalized idiopathic epilepsies like JME. *Rolandic epilepsy* - **Rolandic epilepsy** (benign epilepsy with centrotemporal spikes) often resolves spontaneously and may not require treatment, but if seizures are frequent, drugs like gabapentin or carbamazepine are used. - ACTH has no established role in the treatment of Rolandic epilepsy, which is a **focal idiopathic epilepsy** with a good prognosis. *Lennox Gastaut syndrome* - While a severe epileptic encephalopathy, the initial management for **Lennox-Gastaut syndrome** (LGS) typically involves a combination of antiepileptic drugs such as valproate, lamotrigine, clobazam, or rufinamide. - ACTH may be considered as an adjunctive treatment in refractory cases of LGS, but it is not the **first-line drug of choice**, unlike in West syndrome where it holds a primary role.
Question 5: Child was seen taking off clothes while watching TV; he suddenly closed eyes for some time and was lethargic after some time. He had probably
- A. febrile seizures
- B. Absence seizures
- C. GTCS
- D. Temporal lobe epilepsy (Correct Answer)
Explanation: ***Temporal lobe epilepsy*** - The behavior described, such as **taking off clothes** (automatisms) and subsequent **lethargy** (postictal state), is highly characteristic of a **complex partial seizure**, which often originates in the temporal lobe. - **Eyes closing** during the event and partial awareness suggest that the seizure involved altered consciousness without a complete loss of awareness, typical of focal seizures with impaired awareness. *febrile seizures* - Febrile seizures are typically generalized tonic-clonic seizures that occur in children with a **fever**, which is not mentioned in the scenario. - The described actions like taking off clothes and sudden eye closure are not typical presentations of a classic febrile seizure. *Absence seizures* - Absence seizures involve **brief staring spells** and a momentary loss of consciousness, without the complex motor behaviors (automatisms) like taking off clothes. - There is typically no significant postictal lethargy associated with absence seizures; the child usually resumes activity immediately after the event. *GTCS* - **Generalized tonic-clonic seizures (GTCS)** involve a complete loss of consciousness, followed by tonic (stiffening) and clonic (jerking) phases, often with a loud cry and tongue biting. - While GTCS can lead to postictal lethargy, the specific automatisms (taking off clothes) and the partial impairment of consciousness are more indicative of a focal seizure.
Question 6: Which is not used in status epilepticus?
- A. Lorazepam
- B. Phenytoin
- C. Phenobarbitone
- D. Metformin (Correct Answer)
Explanation: ***Metformin*** - **Metformin** is an **oral hypoglycemic agent** used to treat **type 2 diabetes mellitus** and has no role in the management of seizures or status epilepticus. - Its primary mechanism involves decreasing **hepatic glucose production** and improving **insulin sensitivity**. *Lorazepam* - **Lorazepam** is a first-line treatment for **status epilepticus** due to its rapid onset of action and efficacy in terminating seizures. - It enhances the effect of **GABA** (gamma-aminobutyric acid) at the GABA-A receptor, leading to neuronal hyperpolarization and reduced excitability. *Phenytoin* - **Phenytoin** is a common second-line agent used in status epilepticus, administered after benzodiazepines, to maintain seizure control. - It works by blocking **voltage-gated sodium channels**, thereby stabilizing neuronal membranes and preventing repetitive firing. *Phenobarbitone* - **Phenobarbitone** (phenobarbital) is an effective antiepileptic drug, often considered as a second or third-line agent in status epilepticus, especially when other treatments fail. - It acts primarily by enhancing the activity of **GABA** at the GABA-A receptor, similar to benzodiazepines, but with a longer duration of action.
Question 7: Statement 1 - A 59-year-old patient presents with flaccid bullae. Histopathology shows a suprabasal acantholytic split. Statement 2 - The row of tombstones appearance is diagnostic of Pemphigus vulgaris.
- A. Statements 1 & 2 are correct, 2 is not explaining 1 (Correct Answer)
- B. Statements 1 and 2 are correct and 2 is the correct explanation for 1
- C. Statements 1 and 2 are incorrect
- D. Statement 1 is incorrect
Explanation: ***Correct: Statements 1 & 2 are correct, 2 is not explaining 1*** **Analysis of Statement 1:** - A 59-year-old patient with **flaccid bullae** and **suprabasal acantholytic split** on histopathology is the classic presentation of **Pemphigus vulgaris** - The flaccid (easily ruptured) nature of bullae distinguishes it from tense bullae seen in bullous pemphigoid - The suprabasal location of the split (just above the basal layer) with acantholysis (loss of cell-to-cell adhesion) is pathognomonic - **Statement 1 is CORRECT** ✓ **Analysis of Statement 2:** - The **"row of tombstones" or "tombstone appearance"** is indeed a diagnostic histopathological feature of Pemphigus vulgaris - This appearance results from basal keratinocytes remaining attached to the basement membrane while suprabasal cells separate due to acantholysis - The intact basal cells standing upright resemble a row of tombstones - **Statement 2 is CORRECT** ✓ **Does Statement 2 explain Statement 1?** - Statement 2 describes a **histopathological appearance** (tombstone pattern) that is a **consequence** of the suprabasal split - However, it does NOT explain the **underlying cause** of the flaccid bullae or the suprabasal split - The true explanation involves **IgG autoantibodies against desmoglein 3 (and desmoglein 1)**, which attack intercellular adhesion structures (desmosomes), causing **acantholysis** - Therefore, **Statement 2 does NOT explain Statement 1** ✗ *Incorrect: Statement 2 is the correct explanation for Statement 1* - While both statements describe features of Pemphigus vulgaris, the tombstone appearance is a descriptive finding, not an explanatory mechanism *Incorrect: Statements 1 and 2 are incorrect* - Both statements are medically accurate descriptions of Pemphigus vulgaris features *Incorrect: Statement 1 is incorrect* - Statement 1 correctly describes the cardinal clinical and histopathological features of Pemphigus vulgaris
Question 8: Febrile seizure is called as 'complex' when it lasts for?
- A. > 30 minutes
- B. > 5 minutes
- C. > 10 minutes
- D. > 15 minutes (Correct Answer)
Explanation: ***> 15 minutes*** - A **complex febrile seizure** is defined by one or more of the following characteristics: duration longer than **15 minutes**, occurrence more than once within 24 hours, or a focal nature. - This longer duration distinguishes it from a **simple febrile seizure**, which typically lasts less than 15 minutes. *> 30 minutes* - While a seizure lasting more than **30 minutes** is certainly complex, the clinical threshold for defining a complex febrile seizure is met at **15 minutes**. - A seizure lasting over 30 minutes would also be classified as **status epilepticus**, which is a more severe condition requiring urgent intervention. *> 5 minutes* - A seizure lasting more than **5 minutes** but less than 15 minutes is usually still considered a **simple febrile seizure** if other complex features are absent. - Febrile seizures often last between 2 to 5 minutes, making this duration not typically indicative of complexity on its own. *> 10 minutes* - A seizure lasting more than **10 minutes** is approaching the complex definition but does not quite meet the standard **15-minute threshold** for a complex febrile seizure based on duration. - It is still commonly considered within the range of a simple febrile seizure unless other factors like *focality* or recurrence are present.
Question 9: The percentage of children with simple febrile seizures who develop epilepsy is:
- A. 1-2% (Correct Answer)
- B. 5-10%
- C. 2-5%
- D. 10-20%
Explanation: ***1-2%*** - The risk of developing **epilepsy** after a simple febrile seizure is generally low, estimated to be around **1-2%**. - This low percentage highlights that simple febrile seizures are typically benign and do not commonly lead to chronic seizure disorders. *5-10%* - This percentage is too high for the risk of epilepsy after a **simple febrile seizure**. - A higher risk might be associated with complex febrile seizures or other neurological predisposition. *2-5%* - While closer, this range is still slightly higher than the generally accepted risk for uncomplicated **simple febrile seizures** leading to epilepsy. - This range might be considered for cases with some atypical features, but not for typical simple febrile seizures. *10-20%* - This percentage represents a significantly **elevated risk** that is far beyond what is observed for typical simple febrile seizures. - Such a high risk would indicate a much more serious underlying neurological disorder or complex seizure presentation.
Question 10: Which one of the following childhood epileptic disorders often needs long term treatment with antiepileptic drugs?
- A. Febrile seizures
- B. Juvenile myoclonic epilepsy (Correct Answer)
- C. Benign rolandic epilepsy
- D. Benign neonatal seizures
Explanation: ***Juvenile myoclonic epilepsy*** - This is a **genetic generalized epilepsy syndrome** that typically emerges during adolescence and often requires **lifelong treatment** with antiepileptic drugs due to a high risk of relapse if treatment is discontinued. - Characterized by **myoclonic jerks**, particularly in the morning, along with generalized tonic-clonic and absence seizures. *Febrile seizures* - These are **age-dependent seizures** that occur in association with fever and typically have a **benign prognosis**, rarely requiring long-term antiepileptic drug treatment. - They usually resolve spontaneously by **age 5-6 years**, and the risk of developing epilepsy is low unless there are complex features or underlying neurological conditions. *Benign rolandic epilepsy* - This is an **idiopathic focal epilepsy** of childhood that is characterized by seizures occurring primarily during sleep, with **motor or sensory symptoms** involving the face and mouth. - It has a very **favorable prognosis**, with spontaneous remission typically occurring by adolescence, and many children do not require antiepileptic drugs or only short-term treatment. *Benign neonatal seizures* - This refers to a group of self-limited epileptic syndromes that occur in the first few weeks of life, often with a **hereditary component**, but they typically **resolve spontaneously** within weeks or months. - **Long-term antiepileptic drug treatment** is generally not needed, and the **neurodevelopmental outcome is usually excellent**.
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