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An 18-year-old woman with a history of symptomatic epilepsy presents with medically-refractory seizures. An MRI brain is performed during presurgical evaluation and reveals the non-contrast-enhancing lesion shown below on T2 FLAIR. This lesion is most likely which of the following?
A 32-year-old Chinese male is referred to the epilepsy clinic after experiencing two episodes concerning for possible seizures. The first episode was unwitnessed, but the patient states that there was an abrupt loss of consciousness and that he woke up with the side of his tongue bitten and generalized myalgias. The second event was witnessed by his wife who noticed one day that the patient was unresponsive and lip-smacking for 2 minutes before returning back to baseline. MRI brain was performed and showed left-sided mesial temporal sclerosis. Which of the following medications should be avoided for this patient?
A 35-year-old female with a history of heroin abuse was found unresponsive and received 35 minutes of CPR before a return of spontaneous circulation (ROSC). She was intubated in the field and was brought urgently to the hospital. While in the ICU, the nursing staff noticed abnormal movements concerning for possible seizure. An EEG was performed and shown below. What is this finding most consistent with?
The EEG shown below is consistent with which of the following?
Deep brain stimulation has been FDA approved for the management of medically refractory epilepsy when it targets which of the following structures?
A 28-year-old woman with a history of intractable epilepsy presents to you for outpatient follow-up. She has been seizure-free on valproic acid and levetiracetam for the last 18 months. She reports a desire to become pregnant and asks if she has an increased risk of in-utero defects with her medications. Which of the following is the most appropriate answer to this question?
A 4-year-old male with no significant past medical history presents to the emergency room after experiencing a first-time seizure. An EEG is obtained and captures a seizure arising from the left hemisphere and polymorphic delta slowing on the same side. Over the next several months the child continues to experience focal-onset seizures despite being on 2 maximally-dosed seizure medications. His brain MRI, below, shows asymmetric left-hemispheric atrophy. His clinic presentation and imaging are most consistent with which of the following diseases?
A mother and father bring in their 8-month-old son to your clinic for clinical events described as sudden flexion of the limbs and trunk, seen most often upon awakening or falling asleep. His interictal EEG is demonstrated below. Which of the following is the most likely cause of the patient’s symptoms and EEG findings?
A 4-year-old girl with multiple seizure types and intellectual disability has an EEG performed that shows 1.5 Hz to 2.5 Hz spike and wave discharges. Which of the following is the most likely diagnosis?
Identify the finding noted with a blue arrow.
The following is a sample of gray matter stained with Anti-NeuN and viewed under a low-power microscope lens. The pathology marked by the blue arrow is most consistent with which of the following causes of epilepsy?
A 24-year-old college student presents with uncontrolled epilepsy. His seizures consist of an aura of déjà vu followed by oral automatisms and periods of unresponsiveness. The neurological examination is normal. MRI of the brain is performed and shown below. What is the etiology of this patient’s epilepsy?
A 4-month-old male with no significant past medical history was admitted to the epilepsy monitoring unit with episodes concerning for possible seizures. The family has noticed that events tend to occur when the child is angry. One episode is captured during his stay. The first symptoms appreciated were excessive crying followed by loss of tone and a few myoclonic jerks for 20 seconds. The patient then rapidly returned to baseline thereafter. There were no epileptiform discharges seen during this episode. Based on the most likely diagnosis, what is the most appropriate next step in management?
What is the state of the patient in the EEG shown below?
A 28-year-old woman of Chinese descent was recently diagnosed with focal/symptomatic epilepsy. Which of the following medications should best be avoided in the management of her epilepsy?
The EEG pattern on this bipolar EEG recording is most consistent with which of the following epilepsy syndromes?
Which way are the patient’s eyes moving at the point of the asterisk marked below?
A 14-year-old male is evaluated in your clinic for seizures. Past medical history is significant for brief staring spells in elementary school. Now the patient is having generalized seizures especially when he is sleep-deprived. Additionally, the patient has recently been experiencing jerky movements of both arms in the morning, resulting in him dropping objects from his hands. An EEG shows generalized 4-6 Hz polyspike and wave discharges. What is the most likely diagnosis?
Which of the following is appreciated in the right posterior quadrant in the EEG shown below?
The pathology slide below is most consistent with which of the following disorders?
What is the most likely clinical scenario related to the EEG provided below?
A 5-month-old female is brought to the emergency room by her parents because of an episode concerning for possible seizure. On arrival, the patient appears back to her clinical baseline neurologically. Several hypomelanotic lesions are appreciated while performing a skin check. The mother notes that her older brother has similar skin findings. An EEG is performed and shown below. A typical event was captured that correlated with an electrodecrement of cortical activity on EEG.
Based on the child’s diagnosis, what is the most appropriate therapy?
Which of the following is most consistent with this EEG tracing?
The combination of lamotrigine and which of the following drugs increases the risk of lamotrigine toxicity?
The electrographic pattern appreciated in the 6th second of this recording likely represents which of the following?
A 27-year-old man presents after having an unprovoked generalized tonic-clonic seizure. Which of the following should he be told regarding his clinical situation?
A 6-year-old Amish female presents to the emergency department with a 2-month history of gradual cognitive decline and jerking limb movements. A routine EEG was obtained (see below). Which of the following diseases is consistent with these EEG findings?
A 24-year-old male with no known past medical history experienced a first-time generalized tonic-clonic seizure while at work. She is now in the emergency room and back to her neurological baseline. Bloodwork was unremarkable. A routine EEG and MRI of the brain were normal. Which is the most appropriate next step in management?
Identify the pattern seen in the 5th second of this EEG recording.
Which of the following antiepileptic drugs can induce myoclonic seizures?
Which of the following is the most common cause of focal clonic seizures in full-term neonates?
A patient with medically-refractory epilepsy has an MRI brain performed as part of their pre-surgical workup. Based on the imaging provided, what type of seizures is this patient most likely experiencing?
What clinical diagnosis does this EEG tracing suggest?
A 68-year-old woman presents to the emergency room with a 3-month history of worsening cognition, ataxia, dysphagia, and periodic episodes of brachial dystonia, and facial grimacing. A continuous EEG was performed but no EEG correlate was seen with the abnormal movements. An autoimmune process is suspected. Which of the following serum autoantibodies is most likely present?
A 34-year-old man with medically-refractory epilepsy has an MRI brain completed. The lesion shown (T2 sequence) does not enhance with contrast. If a surgical resection was performed, which of the following would be the most likely seen on pathologic analysis?
What is the mechanism of action of phenobarbital?
Which of the following is a necessary requirement for electrocerebral inactivity (ECI) testing?
A 30-year-old woman with well-controlled epilepsy with lamotrigine monotherapy comes to the clinic today stating that she and her husband are planning to start a family. Which of the following statements is most correct regarding her clinical situation?
Estrogen-containing oral contraceptive pills are known to reduce serum levels of which of the following medications?
A 26-year-old physics teacher and mother on valproic acid (VPA) for epilepsy presents to your clinic with her husband stating she wishes to try to become pregnant soon. She asks how anti-seizure medications (ASMs) used during pregnancy may impact the intelligence and school performance of her child. Which is the most accurate response?
A 6-year-old girl presents to the clinic with frequent episodes of awakening from sleep in extreme fear. Sometimes she has a brief twitching of the limbs with this. She has these events in clusters on some nights, lasting seconds to minutes. On further questioning, you discover the mother had a similar problem when she was around this age, which slowly got better over time. Both patient and mother are otherwise healthy with no intellectual deficits or symptomatic features. Which of the following gene mutations do they both likely share?
Which of the following EEG artifacts is prominently seen on this EEG?
An 8-year-old boy with no significant past medical history is brought to the clinic due to difficulties in school. His mother states that over the past year, she has received multiple phone calls from his teacher about his lack of concentration in class. On multiple occasions when asked a question, the patient would blankly stare at the wall and ignore the teacher, but then would return to his normal, talkative self immediately after each episode. An EEG is ordered, which shows 3 Hz generalized spike and wave discharges. The patient would most likely benefit from a medication targeting what?
Which of the anti-seizure medications (ASMs) listed operates under zero-order kinetics at high doses?
A full-term (40 weeks gestational age) male had an uncomplicated delivery with good APGAR scores. However, the family has noticed unexplained episodes of tremulousness. Because of these abnormal movements, an EEG was ordered. Which of the following is the most accurate description of the findings shown in the epoch below?
A 42-year-old female with a history of epilepsy has an EEG performed while establishing care with a new provider. She admits to knowing very little about what type of epilepsy she has. A 10-second epoch of her study is shown below. Based on the available data, what medication should be avoided in the management of her epilepsy?
What is the electrographic pattern seen best in the right temporal electrodes?
A 40-year-old male with bilateral mesial sclerosis and medically refractory epilepsy presents to the epilepsy monitoring unit for a presurgical evaluation. His current anti-seizure medication regimen includes levetiracetam, lamotrigine, and clobazam. Over three days and weaned medication, the patient had 7 seizures; four from the left temporal lobe, and three from the right temporal lobe. Which of the following is the most appropriate next step in treatment?
Which of the following conditions is most likely to have an associated disorder of abnormal motor activity during the following sleep state?
What task is likely being performed during this EEG recording?
A 9-year-old boy with no significant past medical history was referred to get an EEG because of declining school performance and concern for staring vs. daydreaming episodes. Hyperventilation was performed and shown below. His EEG was otherwise unremarkable. Based on the available data which is the most appropriate next clinical step?
A 7-year-old male with a history of multiple febrile seizures has recently presented repeatedly with new recurrent non-febrile clonic seizures. Which of the following gene mutations is associated with this epilepsy syndrome?
A 19-year-old female who was admitted to the epilepsy monitoring unit for medically refractory epilepsy had one of her typical seizures captured during recording (see below). Which of the following symptoms did the patient most likely experience at the time of this recording?
The EEG pattern shown below is most consistent with which of the following?