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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?
A focal seizure must involve how much cortex in order to be appreciated with scalp EEG recording?
What is the mechanism of action of phenobarbital?
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?
Which of the following is most strongly associated with an increased risk of seizure recurrence after a first unprovoked seizure?
Which of the following conditions is most likely to have an associated disorder of abnormal motor activity during the following sleep state?
Which of the following medications increase the risk of contraceptive failure in patients taking estrogen-containing oral contraceptive pills (OCPs)?
Which way are the patient’s eyes moving at the point of the asterisk marked below?
Which of the following EEG patterns is typically seen over the age of 50?
A patient with a history of focal to bilateral tonic-clonic seizures has an EEG performed to see if they have responded to levetiracetam. Based on the EEG below, from which region of the brain does epileptiform activity arise?
What is the electrographic pattern seen best in the right temporal electrodes?
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?
Sleep spindles can be asynchronous until what age?
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?
Which of the following is not a known side effect of chronic phenytoin use?
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?
Which of the following seizure characteristics are typically seen in patients with temporal lobe epilepsy?
You are caring for a 1-year-old girl with severe refractory epilepsy with frequent focal seizures. She had normal developmental until 3 months of age when she had seizure onset as well as a loss of milestones. Continuous EEG revealed multiple seizure types, with multiple foci of onset in each hemisphere. The seizures appear to migrate between hemispheres on EEG, and clinically. Which gene is most often associated with this disorder?
A 7-year-old boy with no significant past medical history presents to the clinic after declining school performance and daydreaming. A routine EEG is performed and shown below (bipolar montage). Which of the following medications is the most appropriate first-line therapy?
A 4-day-old full-term baby is brought to the hospital for two episodes of generalized stiffening and apnea for less than 1 minute followed by a return to baseline. The physical exam is unremarkable and CTH is negative. The mother reports having similar episodes shortly after birth. What is the most likely cause of the episodes?
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?
Which of the following is most consistent with this EEG tracing?
An 8-year-old girl is noted to have staring spells during class by her teacher. In the office, you are able to provoke an event by having her blow repeatedly into a pinwheel. What is the most likely underlying pathology of her disease?
Which direction are the patient’s eyes moving at the points marked by the green circles?
Which of the following antiepileptic drugs can induce myoclonic seizures?
The EEG shown below is consistent with which of the following?
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?
What clinical diagnosis does this EEG tracing suggest?
Which of the following anti-seizure medications carries the highest risk of major congenital malformations?
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?
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?
Identify the finding noted with a blue arrow.
What is the state of the patient in the EEG shown below?
An 8-year-old patient with new-onset seizures has an MRI performed after seeing you in the clinic. Based on the lesion appreciated in the image, what seizure type does this patient most likely experience?
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 6-year-old developmentally normal male presents after experiencing an episode of jerking of the right side of his mouth and inability to speak lasting 2 minutes. The patient is now back to baseline and has an EEG performed. Based on this clinical picture, which of the following abnormalities would you most expect to see on the EEG?
Identify the finding shown in the EEG below:
A 35-year-old male presents to the neurology clinic for the management of seizures. The patient reports having focal to bilateral tonic-clonic seizures (FTBTC) since the age of 15. His seizures are usually preceded by the smell of burning rubber. He will then have left hand automatisms followed by whole-body tonic-clonic activity. Levetiracetam monotherapy was initially effective. However, 1 year ago seizures returned, occurring once every two months. Lacosamide was added 6 months ago but there has been no significant improvement in his seizure frequency. Levels of these two anti-seizure medications (ASMs) are therapeutic and there have been no concerns regarding medication adherence. What is the most appropriate next step in management?
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?
What is the most likely clinical scenario related to the EEG provided below?
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?
Stevens-Johnson syndrome associated with carbamazepine use is more likely in patients with which of the following HLA alleles?
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?
Identify the pattern seen in the 5th second of this EEG recording.
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?
Hyperammonemia is a side effect seen with which of the following antiepileptic drugs?
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?
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?
Estrogen-containing oral contraceptive pills are known to reduce serum levels of which of the following medications?
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?