Seizure and Epilepsy MCQs

Deep brain stimulation (DBS) therapy uses a pacemaker-like device to deliver targeted electrical stimulation to the anterior nucleus of the thalamus. The therapy is FDA-approved with conditions for adjunctive treatment for partial-onset seizures in adults with medically refractory epilepsy. DBS is also FDA-approved for treatment of advanced Parkinson disease and essential tremor. Reference: Basic & Clinical Pharmacology, Fourteenth Edition By Bertram G. Katzung Page number. 417

Women with epilepsy are often very concerned about pregnancy and what effect the medications might have on fetal development. Planning is the most important component. All women considering pregnancy should be on high doses of folic acid prior to conception. Valproate and barbiturates should be avoided. Those women already on valproate and barbiturates should be switched to other drugs before pregnancy when possible. When seizures are controlled, maintenance medication may be reduced, if possible, to the lowest dose that provides control. If seizures are not controlled, medications and dosages will need to be adjusted prior to pregnancy, if possible. The frequency and severity of seizures may change during pregnancy. Reference: Basic & Clinical Pharmacology, Fourteenth Edition By Bertram G. Katzung Page number 430

The biochemistry points to a syndrome of inappropriate ADH secretion, with a low serum osmolality [2(Na + K) + urea + glucose]. The clinical picture is consistent with small cell carcinoma of the lung, which is often associated with SIADH. SIADH should be diagnosed only after ruling out hypothyroidism and cortisol deficiency. Diuretic use associated hyponatremia could be associated with low normal serum potassium. Reference : Harrison's Principles of Internal Medicine 21 st edition Page 2924

Tumour lysis syndrome (TLS) is a potentially life-threatening complication of massive cellular lysis in cancer, often encountered in bulky, rapidly progressive or chemo-sensitive tumours. It is most commonly seen in haematological malignancy. Hypocalcaemia is a hallmark feature due to precipitation of ionised calcium with phosphate, which is released in large quantities in tumour lysis. Other laboratory features of TLS include: increase in serum uric acid by >25% from baseline; increase in serum potassium by >25% from baseline; increase in serum phosphate by >25% from baseline. Intravenous hydration and rasburicase are first-line treatments and prophylaxis agents in high-risk groups. Reference: Harrison 20 th 2103,3001

The question deals with RA. NSAIDS are not disease modifying agents. They are analgesic and anti-inflammatory. ESR and CRP may be raised in RA. RA has a strong HLA association to DR locus. RA classically causes erosive arthritis. But plain X ray may not be always showing erosions. It can be viewed using MRI or ultrasound.

Explanation: Post-traumatic seizures occur in approximately 17% of patients with brain contusion, subdural hematoma, or prolonged loss of consciousness. Convulsions are uncommon immediately after traumatic brain injury, though brief tonic extensor posturing or clonic movements may occur at impact. Penetrating injuries carry a particularly high risk of subsequent epilepsy development.

Optic atrophy is not a feature of MND. Other features not compatible with the diagnosis are sensory impairment and bladder and bowel dysfunction. Muscle cramps occurring with volitional activities especially in early morning hours can be seen in very early disease. Even though there is severe brain stem dysfunction, Ocular motility will also be spared in MND till late stages ALS especially familial ALS is associated with behavioural dysfunction suggesting a frontal lobe dysfunction. Cognitive changes don't occur in MND. Reference: Harrison's Principles of Internal Medicine, 21 st ed, Ch: 437, Pg: 3411-3412

This patient presents with a clinical picture consistent with megaloblastic anemia . Megaloblastic anemia is either due to Folic acid or Vitamin B12 deficiency. Given her history of heavy alcohol intake and phenytoin usage, folate deficiency is the most likely cause. Reference : Harrison's Principles of Internal Medicine, 21 st ed, ch: 99, Pg: 773