Quiz

Q1: A lateralized ≥5–7 Hz seizure discharge within 30 s of seizure onset (as given in the figure below) is prototype of ictal onset from which part of the following areas on the ipsilateral side?

• A.– Medial temporal (hippocampal) onset

• B.– Neocortical temporal onset

• C.– Extra-temporal onset

• D.– No definite role

Q2: A 28-year-old lady has presented with refractory epilepsy of 12 yrs duration. She was getting 2–3 seizures per month. Semiology: an aura of fear followed by confusional state with oroalimentary and bimanual automatisms. She is amnesic for the event. There is rarely secondary generalization. She had a single febrile convulsion at the age of 2 years. No family history epilepsy was noted. Her IQ was 82 and she has left temporal deficits on neuropsychology. She was right handed. Her MRI brain was normal (figure 1) and interictal FDG PET showed left temporal hypometabolism (Fig. 2). The ictal EEG showed a left regional temporal rhythm. Can surgery – left standard temporal lobectomy be planned?

• A.– Depth Electrode monitoring must be done before surgery

• B.– She is not a candidate for epilepsy surgery

• C.– It is a case of MRI negative and PET positive Temporal lobe epilepsy and surgical outcome likely to be good

• D.– It is a case of MRI negative and PET positive Temporal lobe epilepsy and surgical outcome likely to be poor

Q3: Single most important predictor of favourable outcome after epilepsy surgery is

• A.– History of febrile convulsions

• B.– Lesion on MRI

• C.– Clear-cut EEG lateralization

• D.– Lateralization on neuropsychology

Q4: A 32-year-old male with intractable seizures and a normal MRI scan undergoes a non-invasive evaluation. Based on scalp EEG and seizure semiology, he had subdural electrodes placed and seizures were localized to the left language dominant supplementary motor area. Following surgical resection the patient will most likely exhibit:

• A.– Verbal memory deficits

• B.– Temporary paresis on the left

• C.– Temporary mutism and anomia

• D.– Left inferior quadrantopsia

Q5: Which drug should be avoided in children with epilepsy due to suspected POLG MUTATION?

• A.– Phenytoin

• B.– Valproate

• C.– Carbamazepine

• D.– Levitiracetam

Q6: What is the MRI abnormality noted in the figure given below?

• A.– Right hemiatrophy

• B.– Left hemimegalencephaly

• C.– Right hemispherical polymicrogyria

• D.– Pachygyria left hemisphere

Q7: Starry sky appearance on CT brain as given below in a 9-year-child with uncontrolled seizures and progressive cognitive decline. What is the diagnosis?

• A.– Multiple neurocysticercosis

• B.– Multiple tuberculomas

• C.– Multiple tubers in tuberous sclerosis

• D.– Multiple cryptcoccomas

Q8: In the land mark study by Kwan and Brodie, treatment with a single AED was effective in about what percent of patients with newly diagnosed epilepsy?

• A.– 10%

• B.– 20%

• C.– 30%

• D.– 50%

Q9: Below is the MRI brain in a six-year-child with refractory epilepsy from one year of age. What is likely to be the special character of seizures in this child?

• A.– Ictal fear and palpitations

• B.– Ictal singing

• C.– Ictal speech

• D.– Gelastic seizures

Q10: Spot the diagnosis based the EEG below in an 18-year-old lady who presented with fever seizures and altered sensorium.

• A.– SSPE

• B.– CJD

• C.– HSV encephalitis

• D.– Brain abscess