MCQs on Epilepsy

• Q1. If a patient experiences one unprovoked seizure, which of the following extra symptoms should present, to diagnose it as epilepsy?

  • The patient is younger than 2 years.

  • There is an estimated 60% or greater likelihood of another unprovoked seizure occurring within the next 10 years.

  • The patient has a family history of febrile seizures in two or more first-degree relatives.

  • History of a provoked seizure.

  • The seizure lasts longer than 20 minutes.

  Correct Answer: b. There is an estimated 60% or greater likelihood of another unprovoked seizure occurring within the next 10 years. As per ILAE 2014, epilepsy can be diagnosed when (1) there are two unprovoked or reflex seizures occurring more than 24 hours apart, (2) single unprovoked or reflex seizure with a probability of another seizure similar to general recurrence risk of at least 60% occurring over the next 10 years, and (3) diagnosis of epilepsy syndrome.

• Q2. Based on the 2017 classification system by the International League Against Epilepsy (ILAE), what is the appropriate term for a seizure that starts in a neuronal network limited to a single hemisphere?

  • Isolated seizure

  • Generalized seizure

  • Focal seizure

  • Hemispheric seizure

  • Partial seizure

  Correct Answer: c. Focal seizure. In the 2017 ILAE classification system, “focal” is now used in place of the term “partial.”

• Q3. A seizure characterized by sudden, irregular, and arrhythmic jerking is classified as which type of seizure?

  • Atonic seizure

  • Clonic seizure

  • Hyperkinetic seizure

  • Tonic seizure

  • Myoclonic seizure

  Correct Answer: e. Myoclonic seizure. Myoclonic jerks are characterized by focal, irregular, and nonrhythmic movements. In contrast, clonic jerks are rhythmic and repetitive. Focal atonic seizures result in a loss of muscle tone in a localized body part. Tonic seizures are associated with increased muscle tone, often affecting an extremity or the neck. Hyperkinetic seizures are identified by excessive motor activity, such as thrashing or pedaling motions.

• Q4. As per International League Against Epilepsy (ILAE), drug-resistant epilepsy is defined as a condition in which _________ properly selected and well-tolerated different antiseizure medications fail to control seizures?

  • One

  • Two

  • Three

  • Four

  Correct Answer: b. Two. The Task Force of the ILAE Commission on Therapeutic Strategies defines drug-resistant epilepsy as the inability to control seizures despite trying two appropriately chosen and well-tolerated antiseizure medications.

• Q5. Juvenile myoclonic epilepsy is classified under which of the following causes or categories?

  • Metabolic

  • Genetic

  • Immune

  • Structural

  • Unknown

  Correct Answer: b. Genetic. The latest ILAE classification categorizes epilepsy into six etiological categories: structural, infectious, metabolic, immune, genetic, and unknown. A genetic cause is indicated by the identification of a known mutation, clinical features supported by supplementary data and family history, or a syndrome backed by research indicating a genetic origin. The genetic basis of juvenile myoclonic epilepsy is reinforced by research findings.

• Q6. A 12-day old infant presented with seizures at 12 days of age, on evaluation MRI revealed intracranial calcifications, polymicrogyria, and ventricular enlargement. The most likely associated etiology is

  • Genetic

  • Infectious

  • Immune

  • Metabolic

  • Unknown

  Correct Answer: b. Infectious. The likely etiology in the given infant is cytomegalovirus infection.

• Q7. Which of the below mentioned is not a feature of adverse effects of sodium valproate?

  • Secondary nocturnal enuresis

  • Excessive hair growth

  • Thrombocytopenia

  • Hemorrhagic pancreatitis

  Correct Answer: b. Excessive hair growth. Adverse effects of valproate treatment include dose-related tremor, hyperammonemic encephalopathy, hepatotoxicity, polycystic ovaries, thrombocytopenia, altered platelet function, and acute hemorrhagic pancreatitis. Excessive weight gain is another common side effect; this is not entirely due to increased appetite, but is felt to be due to decreased β-oxidation of fatty acids. Secondary nocturnal enuresis is a side effect of valproate treatment in children. Excessive hair shedding (rather than growth) may occur; it is typically temporary, though the hair that regrows may have a different texture and color. Facial and limb edemas are also noted. Lower IQ has been noted by age 3 years in children whose mothers took valproate for epilepsy. 1% to 2% of fetuses exposed to valproate developed neural tube defects in the first trimester of pregnancy, and folate supplementation can be protective. The occurrence of rash with valproate therapy is very rare.

• Q8. Which of the following is the preferred treatment for epilepsy caused by glucose transporter type 1 (GLUT1) deficiency?

  • Functional hemispherectomy

  • Valproic acid

  • Ketogenic diet

  • Phenobarbital

  • Vagal nerve stimulation

  Correct Answer: c. Ketogenic diet. This condition is diagnosed through low cerebrospinal fluid (CSF) glucose levels during fasting and is linked to mutations in the SLC2A1 gene. It typically presents with seizure clusters and status epilepticus during periods of fasting. The ketogenic diet is particularly effective in managing seizures and improving the patient's overall health.

• Q9. A new mutation in the STXBP1 gene is most commonly associated with which type of epilepsy?

  • Generalized tonic-clonic seizures

  • Epileptic encephalopathy with onset in early infancy

  • Focal seizures with altered awareness

  • Benign familial neonatal seizures

  Correct Answer: b. Epileptic encephalopathy with onset in early infancy. STXBP1 mutations are known to result in a severe form of early-onset epileptic encephalopathy. This gene encodes syntaxin-binding protein 1, which plays a critical role in neurotransmitter release. Mutations often result in profound developmental delays and intractable seizures from infancy. Other forms of epilepsy, like benign familial neonatal seizures, are more often linked to mutations in genes such as KCNQ2 or KCNQ3.

• Q10. Which genetic mutation is frequently linked to febrile seizures plus (FS + ), a condition that encompasses generalized epilepsy with febrile seizures plus (GEFS + )?

  • SCN1B

  • PRRT2

  • CHRNA2

  • CACNA1A

  Correct Answer: a. SCN1B. Mutations in the SCN1B gene, which encodes the β1 subunit of the voltage-gated sodium channel, are often associated with the GEFS+ spectrum. This condition presents with febrile seizures in infancy or childhood and can progress to more generalized forms of epilepsy, including generalized tonic-clonic seizures. PRRT2 is associated with benign infantile epilepsy and paroxysmal kinesigenic dyskinesia, while CACNA1A mutations are linked to episodic ataxia and some epileptic conditions, but not typically GEFS + .

• Q11. What is the most suitable antiseizure medication for a child with infantile spasms due to tuberous sclerosis?

  • ACTH

  • Gabapentin

  • Oral prednisolone

  • Vigabatrin

  • Pyridoxine

  Correct Answer: d. Vigabatrin. Currently, vigabatrin is the most evidence-backed treatment for individuals with infantile spasms related to tuberous sclerosis. Adrenocorticotropic hormone administered intramuscularly is typically the preferred option for infantile spasms caused by other etiologies.

• Q12. During pregnancy, which of the following is likely to influence lamotrigine?

  • Liver enzyme suppression

  • Liver enzyme induction

  • Increased absorption

  • Decreased plasma volume of distribution

  • Decreased renal clearance

  Correct Answer: b. Liver enzyme induction. During pregnancy, the most common cause of seizure recurrence in women with epilepsy is a decrease in the plasma levels of antiseizure medications, particularly lamotrigine. This decrease is largely due to metabolic changes, which can be concerning for lamotrigine. Around 40% of pregnant women on lamotrigine experience lower plasma concentrations, leading to more frequent seizures. This decline is primarily due to the induction of metabolism through hepatic glucuronidation, driven by sex hormones, which increases drug clearance by two to three times. Other factors that may contribute to lower plasma levels of antiseizure drugs during pregnancy include reduced drug absorption and an expanded plasma volume of distribution.

• Q13. Which antiseizure medication is most likely to deteriorate depression and increase suicidal risk in patients with a pre-existing mood disorder?

  • Gabapentin

  • Valproate

  • Oxcarbazepine

  • Levetiracetam

  • Lamotrigine

  Correct Answer: d. Levetiracetam. Levetiracetam has been linked to increased suicidal risk and behavioral changes, so it is recommended to avoid it in patients with epilepsy with history of mood disorders. Other antiseizure medications with increased suicidal risk are topiramate, tiagabine, and vigabatrin. On the other hand, lamotrigine, valproate, and carbamazepine have mood-stabilizing effects and may be appropriate in managing depression in individuals with epilepsy.

• Q14. The most common cause of mortality in individuals with epilepsy is linked to which of the following?

  • Drowning

  • Falls with injuries

  • Road traffic accidents

  • Underlying medical disorders

  • Sudden unexpected death in epilepsy (SUDEP)

  Correct Answer: d. Underlying medical disorders. Mortality rates in people with epilepsy are higher, with odds ratios between 1.6 and 3.0 for adults and 6.4 to 7.5 for those with epilepsy that begins in childhood. This increased mortality is primarily attributed to the underlying medical conditions associated with epilepsy, rather than deaths caused by seizure-related injuries or sudden unexpected death in epilepsy.

• Q15. Which of the following is NOT associated with an increased risk of sudden unexpected death in epilepsy (SUDEP)?

  • Epilepsy that begins in adulthood

  • Frequent generalized tonic-clonic seizures

  • Use of two or more antiseizure drugs

  • Being male

  Correct Answer: a. Epilepsy that begins in adulthood. The recognized risk factors for SUDEP include male sex (with males having a 1.4 times higher risk than females), early onset of epilepsy (risk is 1.7 times higher when epilepsy begins before 16 years old compared with ages 16–60), long duration of epilepsy (with twice the risk for those with epilepsy lasting over 15 years), a history of generalized tonic-clonic seizures (with odds ratios of 2.94 for 1–2 seizures per year, 8.28 for 3–12 seizures per year, 9.06 for 13–50 seizures per year, and 14.51 for more than 50 seizures per year), and the use of multiple antiseizure medications (three times the risk compared with those on a single medication).

• Q16. Which enzyme system is primarily involved in the metabolism of lamotrigine, and co-administration with which of the following drugs can significantly reduce lamotrigine's clearance?

  • CYP2C19; co-administration with carbamazepine

  • CYP2E1; co-administration with phenobarbital

  • UDP-glucuronosyltransferase (UGT); co-administration with valproate

  • CYP3A4; co-administration with phenytoin

  Correct Answer: c. UDP-glucuronosyltransferase (UGT); co-administration with valproate. Lamotrigine is primarily metabolized via UGT enzymes, and valproate inhibits this pathway, leading to a significant reduction in lamotrigine clearance and increased risk of toxicity. Co-administration requires careful monitoring and dose reduction of lamotrigine. In contrast, enzyme-inducing AEDs like carbamazepine and phenytoin can increase lamotrigine metabolism.

• Q17. Which of the following has the best overall prognosis?

  • Continuous spike and wave during slow sleep

  • Early myoclonic epilepsy

  • Epilepsy of infancy with migrating focal seizures

  • Lennox–Gastaut syndrome

  • Landau–Kleffner syndrome

  Correct Answer: e. Landau–Kleffner syndrome. Among the listed epileptic encephalopathies, Landau–Kleffner syndrome has the most favorable outcome. Patients with this condition typically do not experience severe epilepsy, and treatment of electrical status epilepticus during slow sleep often leads to resolution or marked improvement in acquired auditory agnosia. In contrast, individuals with continuous spike-and-wave patterns often suffer from significant cognitive impairments and treatment-resistant epilepsy. Both early myoclonic epilepsy and epilepsy of infancy with migrating focal seizures are classified as early-onset epileptic encephalopathies and they generally have poor outcomes regarding seizure control and developmental progress, unless the cause is a structural issue that can be surgically addressed (like hemimegalencephaly) or a metabolic disorder (such as pyridoxine-dependent epilepsy) which can be treated. Lennox–Gastaut syndrome is characterized by multiple seizure types, developmental delay, and treatment-resistant epilepsy leading to a generally poor prognosis.

• Q18. Which of the following statements accurately describes Lennox–Gastaut syndrome?

  • Daily seizures become uncommon over the long term

  • Nonconvulsive status epilepticus (NCSE) is a risk factor for cognitive impairment

  • The ketogenic diet is beneficial for a small number of patients.

  • Vagus nerve stimulation (VNS) is more effective than corpus callosotomy for atonic seizures

  Correct Answer: b. Nonconvulsive status epilepticus (NCSE) is a risk factor for cognitive impairment. In Lennox–Gastaut syndrome (LGS), about two-thirds of patients still experience daily seizures 10 years after diagnosis. Factors linked to an increased risk of severe cognitive decline in individuals with LGS include nonconvulsive status epilepticus (NCSE), a previous diagnosis of West syndrome, a symptomatic cause, and an early onset of epilepsy. Of these, NCSE is regarded as the most significant risk factor. The ketogenic diet and VNS are effective with 50% of children experiencing >50% reduction in seizures. Some patients can have >90% seizure reduction with the ketogenic diet. Corpus callosotomy and VNS have similar rates of seizure reduction, but corpus callosotomy is felt to be more effective for atonic seizures.

• Q19. Interictal epileptiform discharges occur LEAST frequently in:

  • N3 sleep

  • N1 sleep

  • N2 sleep

  • REM sleep

  Correct Answer: d. REM sleep. Studies show that REM sleep is the least likely stage to display interictal epileptiform discharges, whereas N3 (slow wave sleep) is the most likely phase to show these discharges. This is due to enhanced synchronization during slow wave sleep and relative desynchronization during REM sleep.

• Q20. Which of the following antiseizure medications has the longest half-life period?

  • Zonisamide

  • Phenytoin

  • Perampanel

  • Sodium valproate

  • Stiripentol

  Correct Answer: c. Perampanel. It has the longest half-life of 104 hours followed by zonisamide (60 hours).

Publication History

Article published online:
10 November 2025