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A seizure is fundamentally defined as a sudden, brief disruption of brain activity caused by abnormal, excessive, or synchronous firing of neurons.
Answer: True
Explanation: The definition of a seizure involves a sudden, brief disruption of brain activity resulting from abnormal, excessive, or synchronous neuronal firing.
The terms 'epileptic fits,' 'seizures,' 'fits,' and 'convulsions' are often used interchangeably to describe an epileptic seizure.
Answer: True
Explanation: Common terminology for an epileptic seizure includes 'epileptic fits,' 'seizures,' 'fits,' and 'convulsions,' which are frequently used interchangeably.
Emergency Medicine physicians are primarily responsible for the long-term management of epileptic seizures, while neurologists handle acute cases.
Answer: False
Explanation: Neurologists primarily manage long-term epileptic seizures, while Emergency Medicine physicians address acute cases, as indicated by their respective specializations.
Most seizures typically last longer than five minutes and are immediately followed by a full return to normal function without a recovery phase.
Answer: False
Explanation: Most seizures typically last less than two minutes and are followed by a postictal recovery phase, not an immediate return to normal function.
Epilepsy is defined by the occurrence of recurrent unprovoked seizures.
Answer: True
Explanation: Epilepsy is precisely defined by the occurrence of recurrent seizures that are not provoked by an immediate, identifiable cause.
Which of the following is NOT a common alternative name for an epileptic seizure?
Answer: Strokes
Explanation: Common alternative names for an epileptic seizure include 'epileptic fits,' 'convulsions,' and 'fits,' but 'strokes' refer to a different neurological event.
What is the typical duration of most seizures before a postictal period begins?
Answer: Less than two minutes
Explanation: Most seizures typically last less than two minutes, after which a postictal recovery period usually commences.
What medical condition is defined by recurrent unprovoked seizures?
Answer: Epilepsy
Explanation: Epilepsy is defined as a neurological condition characterized by recurrent seizures that occur without an immediate, identifiable provoking factor.
Motor symptoms during a seizure can include muscle stiffening, rhythmic jerking, or a sudden loss of muscle tone.
Answer: True
Explanation: Motor symptoms during a seizure can manifest as muscle stiffening (tonic), rhythmic jerking (clonic), or a sudden loss of muscle tone (atonia), reflecting varied brain activity.
An 'aura' is a post-seizure sensation that helps individuals recover from the event.
Answer: False
Explanation: An 'aura' is a subjective sensation experienced *before* a seizure fully progresses, serving as a warning sign, not a post-seizure recovery aid.
The International League Against Epilepsy (ILAE) released an updated classification system in 2025.
Answer: True
Explanation: The International League Against Epilepsy (ILAE) released an updated classification system for seizures in 2025, categorizing them by onset, features, and awareness.
Focal seizures originate in both hemispheres of the brain simultaneously.
Answer: False
Explanation: Focal seizures originate within a neural network limited to one hemisphere of the brain, not simultaneously in both.
Focal seizures are subdivided based on whether consciousness is preserved or impaired during the event.
Answer: True
Explanation: Focal seizures are indeed subdivided based on whether a patient's consciousness is preserved or impaired during the seizure event, as per classification systems.
Some focal seizures can evolve into generalized tonic-clonic seizures, spreading to both hemispheres.
Answer: True
Explanation: Some focal seizures can progress to focal-to-bilateral tonic-clonic seizures, where the abnormal activity spreads from one hemisphere to both.
Generalized seizures are initially limited to one hemisphere before potentially spreading.
Answer: False
Explanation: Generalized seizures originate at a specific point but rapidly spread across both hemispheres, unlike focal seizures which are initially limited to one.
Absence seizures and generalized tonic-clonic seizures are both forms of generalized seizures.
Answer: True
Explanation: Absence seizures and generalized tonic-clonic seizures are indeed recognized forms of generalized seizures, each with distinct clinical presentations.
Generalized tonic-clonic seizures are associated with the lowest morbidity and mortality among generalized seizure types.
Answer: False
Explanation: Generalized tonic-clonic seizures are associated with the *highest* morbidity and mortality among generalized seizure types, and are a primary risk factor for sudden unexpected death in epilepsy (SUDEP).
A seizure is classified as 'unknown onset' when there is insufficient information to determine if it is focal or generalized.
Answer: True
Explanation: A seizure is designated as 'unknown onset' when clinical data are insufficient to definitively classify it as either focal or generalized.
An 'aura' in the context of seizures is best described as:
Answer: A subjective sensation experienced before a seizure fully progresses
Explanation: An 'aura' is a subjective sensation that precedes a seizure, serving as a warning sign, and is not a post-seizure recovery phase.
According to the ILAE 2025 classification system, which of the following is NOT one of the four major types of seizures?
Answer: Provoked
Explanation: The ILAE 2025 classification system lists focal, generalized, unknown onset, and unclassified as major seizure types, while 'provoked' refers to the etiology, not a seizure type.
Where do focal seizures originate?
Answer: Within a neural network limited to one hemisphere of the brain
Explanation: Focal seizures originate within a neural network confined to a single hemisphere of the brain.
Which type of generalized seizure is associated with the highest morbidity and mortality?
Answer: Generalized tonic-clonic seizures
Explanation: Generalized tonic-clonic seizures are associated with the highest morbidity and mortality among generalized seizure types, including being a primary risk factor for SUDEP.
A seizure is classified as 'unknown onset' when:
Answer: There is insufficient information to determine if it is focal or generalized.
Explanation: A seizure is classified as 'unknown onset' when there is insufficient clinical information to determine whether its origin is focal or generalized.
Seizures are broadly classified as either provoked, meaning they have an identified immediate trigger, or unprovoked, meaning no immediate trigger is identified.
Answer: True
Explanation: Seizures are categorized as either provoked, having an identifiable immediate trigger, or unprovoked, lacking such a trigger, which is fundamental for diagnosis and treatment.
Status epilepticus is a benign condition that rarely leads to long-term brain injury or death.
Answer: False
Explanation: Status epilepticus is a medical emergency that can lead to severe outcomes, including long-term brain injury or death, and is not considered benign.
Identifying the underlying cause of a seizure is important only for assessing the risk of recurrence, not for treatment decisions.
Answer: False
Explanation: Identifying the underlying cause of a seizure is crucial for both guiding treatment decisions and assessing the risk of recurrence, enabling targeted interventions.
Hypoglycemia, hyponatremia, and uremia are common metabolic disturbances that can provoke seizures.
Answer: True
Explanation: Metabolic disturbances such as hypoglycemia, hyponatremia, and uremia are well-known factors that can provoke seizure activity by acutely affecting brain function.
Meningitis and encephalitis are central nervous system infections that can lead to provoked seizures.
Answer: True
Explanation: Central nervous system infections like meningitis and encephalitis are recognized causes of provoked seizures due to inflammation and damage within the brain.
Acute brain injuries like stroke or traumatic brain injury can cause provoked seizures.
Answer: True
Explanation: Acute brain injuries, including stroke and traumatic brain injury, are known to cause provoked seizures by disrupting normal brain tissue and electrical activity.
Fever is a common cause of provoked seizures, particularly in adults.
Answer: False
Explanation: Fever is a common cause of provoked seizures, but primarily in children, leading to febrile seizures, rather than adults.
Unprovoked seizures are characterized by an immediate precipitating event, unlike provoked seizures.
Answer: False
Explanation: Unprovoked seizures occur without an immediate precipitating event, distinguishing them from provoked seizures which have an identifiable trigger.
Brain tumors and malformations of cortical development are structural brain abnormalities that can cause unprovoked seizures.
Answer: True
Explanation: Structural brain abnormalities such as brain tumors and malformations of cortical development are recognized causes of unprovoked seizures.
Genetic factors, such as mutations affecting neuronal excitability, are not considered a cause of unprovoked seizures.
Answer: False
Explanation: Genetic factors, including mutations affecting neuronal excitability, are indeed a recognized cause of unprovoked seizures, leading to various genetic epilepsies.
Seizures result from a disruption of the normal balance between excitatory and inhibitory neurotransmission in the brain.
Answer: True
Explanation: Seizures arise from an imbalance between excitatory and inhibitory neurotransmission, leading to abnormal, excessive, and hypersynchronous neuronal activity.
Ictogenesis refers to the recovery period after a seizure, known as the postictal state.
Answer: False
Explanation: Ictogenesis describes the process of a seizure's generation, the transition from an interictal to an ictal state, not the postictal recovery period.
Brief seizures, such as absence seizures, always cause observable brain damage.
Answer: False
Explanation: Brief seizures, such as absence seizures, do not typically cause observable brain damage, unlike more prolonged or recurrent seizure activity.
Recurrent seizures are linked to brain tissue scarring, neuronal death, and atrophy.
Answer: True
Explanation: Recurrent seizures are associated with long-term brain changes including gliosis (scarring), neuronal death, and atrophy, contributing to epileptogenesis.
Which of the following is a common metabolic disturbance that can provoke seizures?
Answer: Hypoglycemia
Explanation: Hypoglycemia (low blood sugar) is a common metabolic disturbance that can acutely affect brain function and provoke seizures.
Which central nervous system infection is mentioned as a cause of provoked seizures?
Answer: Meningitis
Explanation: Meningitis is explicitly mentioned as a central nervous system infection that can lead to provoked seizures.
What is a common cause of provoked seizures specifically in children?
Answer: Fever
Explanation: Fever is a common cause of provoked seizures, particularly in children, leading to febrile seizures.
What distinguishes unprovoked seizures from provoked seizures?
Answer: Unprovoked seizures occur without an immediate precipitating event.
Explanation: Unprovoked seizures are characterized by the absence of an immediate precipitating event, distinguishing them from provoked seizures which have an identifiable trigger.
What is the cellular mechanism underlying seizures?
Answer: Abnormal, excessive, and hypersynchronous neuronal activity.
Explanation: Seizures are fundamentally caused by abnormal, excessive, and hypersynchronous neuronal activity, reflecting an imbalance in brain neurotransmission.
What is 'ictogenesis' in the context of seizures?
Answer: The process of a seizure's generation.
Explanation: Ictogenesis refers to the dynamic process by which a seizure is generated, transitioning from a normal or interictal state to an ictal state.
Which type of seizure is explicitly stated NOT to cause observable brain damage?
Answer: Brief absence seizures
Explanation: Brief absence seizures, typically lasting 5-10 seconds, are explicitly stated not to cause observable brain damage.
An electroencephalogram (EEG) showing generalized 3 Hz spike and wave discharges is characteristic of epilepsy.
Answer: True
Explanation: An EEG displaying generalized 3 Hz spike and wave discharges is a characteristic finding in epilepsy, as described in the source material.
Epilepsy can be diagnosed after one unprovoked seizure if there is a recurrence risk of at least 60% over the next 10 years.
Answer: True
Explanation: One diagnostic criterion for epilepsy is a single unprovoked seizure coupled with a recurrence risk of at least 60% over the subsequent 10 years.
The primary goal of clinical evaluation after a seizure is solely to determine the specific type of seizure.
Answer: False
Explanation: The primary goal of clinical evaluation extends beyond merely determining seizure type to confirming if the event was epileptic, identifying its cause, and differentiating it from mimics.
Eyewitness accounts are often crucial for an accurate seizure diagnosis because individuals rarely recall their own seizure details.
Answer: True
Explanation: Eyewitness accounts are vital for accurate seizure diagnosis as patients often have no recall of the event, and observers can provide critical ictal and postictal details.
Lateral tongue bites are a definitive sign of a generalized tonic-clonic seizure, occurring in all cases.
Answer: False
Explanation: Lateral tongue bites strongly suggest a generalized tonic-clonic seizure but occur in only about one-third of cases, thus not a definitive sign in all instances.
Serum glucose and electrolyte panels are common laboratory tests when a provoked seizure cause is suspected.
Answer: True
Explanation: When a provoked seizure is suspected, common laboratory tests include serum glucose and electrolyte panels to identify metabolic disturbances.
A normal electroencephalogram (EEG) definitively rules out an epilepsy diagnosis.
Answer: False
Explanation: A normal electroencephalogram (EEG) does not definitively rule out an epilepsy diagnosis, as epileptiform abnormalities may not be present during the recording.
Magnetic resonance imaging (MRI) is the preferred brain imaging modality for detecting structural abnormalities in new-onset unprovoked seizures.
Answer: True
Explanation: Magnetic resonance imaging (MRI) is the preferred brain imaging modality for new-onset unprovoked seizures to identify underlying structural abnormalities.
Syncope, psychogenic nonepileptic seizures (PNES), and migraine aura are conditions that can mimic epileptic seizures.
Answer: True
Explanation: Conditions such as syncope, psychogenic nonepileptic seizures (PNES), and migraine aura are important differential diagnoses as they can clinically mimic epileptic seizures.
Which of the following is a diagnostic criterion for epilepsy based on unprovoked seizures?
Answer: Two or more unprovoked seizures occurring more than 24 hours apart.
Explanation: One diagnostic criterion for epilepsy is the occurrence of two or more unprovoked seizures separated by more than 24 hours.
Why are eyewitness accounts important in diagnosing seizures?
Answer: Most individuals do not recall the details of their own seizures.
Explanation: Eyewitness accounts are crucial for seizure diagnosis because individuals often lack recall of their own seizure events, making observer details invaluable.
Which physical finding, though occurring in only about one-third of cases, strongly suggests a generalized tonic-clonic seizure?
Answer: Lateral tongue bites
Explanation: Lateral tongue bites, observed in approximately one-third of cases, are a strong indicator of a generalized tonic-clonic seizure.
Which brain imaging modality is preferred for detecting structural abnormalities in new-onset unprovoked seizures?
Answer: Magnetic Resonance Imaging (MRI)
Explanation: Magnetic Resonance Imaging (MRI) is the preferred brain imaging modality for identifying structural abnormalities in cases of new-onset unprovoked seizures.
A seizure lasting exactly five minutes is considered a medical emergency requiring immediate intervention.
Answer: True
Explanation: A seizure that persists for more than five minutes is defined as status epilepticus, a medical emergency necessitating immediate intervention to prevent severe outcomes.
During a tonic-clonic seizure, it is crucial to restrain the person's movements and place an object in their mouth to prevent tongue swallowing.
Answer: False
Explanation: During a tonic-clonic seizure, one should never restrain movements or place objects in the person's mouth; instead, focus on ensuring safety and maintaining an open airway.
Benzodiazepines are the first-line therapy for status epilepticus in emergency care.
Answer: True
Explanation: Benzodiazepines are the recommended first-line therapy for status epilepticus in emergency settings, with early administration improving outcomes.
Long-term antiseizure medications are typically required for provoked seizures, even after the underlying cause is resolved.
Answer: False
Explanation: For provoked seizures, long-term antiseizure medications are generally not required once the underlying acute and reversible cause has been addressed.
After a first unprovoked seizure, antiseizure medication is always started immediately, regardless of other risk factors.
Answer: False
Explanation: Antiseizure medication after a first unprovoked seizure is considered based on identified risk factors for epilepsy, not as an immediate, universal intervention.
The main goals of long-term epilepsy management include achieving seizure control and minimizing adverse treatment effects.
Answer: True
Explanation: Long-term epilepsy management aims to achieve optimal seizure control, minimize adverse treatment effects, and enhance the patient's overall quality of life.
Brain surgery for epilepsy is only considered for palliative outcomes, never for curative ones.
Answer: False
Explanation: Epilepsy surgery can aim for both curative outcomes, where seizures are eliminated, and palliative outcomes, where seizure frequency is significantly reduced.
Which medical condition is considered a medical emergency if a seizure lasts longer than its typical duration?
Answer: Status epilepticus
Explanation: A seizure lasting longer than five minutes is defined as status epilepticus, a medical emergency requiring immediate intervention.
Which of the following is NOT a recommended first aid step for someone experiencing a tonic-clonic seizure?
Answer: Restraining their movements.
Explanation: Restraining a person's movements is explicitly not recommended during a tonic-clonic seizure; instead, focus on protecting them from injury.
What is the first-line therapy for status epilepticus in emergency care?
Answer: Administration of a benzodiazepine
Explanation: The first-line therapy for status epilepticus in emergency care is the administration of a benzodiazepine to rapidly terminate seizure activity.
What is the primary treatment approach for provoked seizures?
Answer: Addressing the underlying acute and reversible cause.
Explanation: The primary treatment for provoked seizures involves identifying and addressing the underlying acute and reversible cause, rather than initiating long-term antiseizure medication.
When might antiseizure medication be considered after a first unprovoked seizure?
Answer: If risk factors for epilepsy, such as epileptiform abnormalities on EEG, are identified.
Explanation: Antiseizure medication may be considered after a first unprovoked seizure if specific risk factors for epilepsy, such as epileptiform abnormalities on EEG or structural lesions on MRI, are identified.
What is the typical starting approach for anti-seizure medication in epilepsy management?
Answer: Starting with one anti-seizure medication.
Explanation: The typical approach for initiating anti-seizure medication in epilepsy management is to start with a single medication, adjusting or adding others if seizure control is not achieved.
What is the difference between a curative and a palliative outcome in epilepsy surgery?
Answer: Curative means seizures are eliminated, palliative means frequency is significantly reduced.
Explanation: In epilepsy surgery, a curative outcome signifies complete seizure elimination, whereas a palliative outcome denotes a significant reduction in seizure frequency.
Falling, drowning, and car accidents are among the potential complications associated with seizures.
Answer: True
Explanation: Potential complications of seizures include physical injuries such as falling, drowning, and car accidents, as well as pregnancy complications and emotional health issues.
The prognosis for individuals with a single provoked seizure due to a reversible cause is generally poor, with a high risk of recurrence.
Answer: False
Explanation: The prognosis for a single provoked seizure due to a reversible cause is generally favorable, with a low risk of recurrence once the underlying issue is resolved.
The estimated lifetime risk of experiencing at least one seizure in the general population is approximately 8-10%.
Answer: True
Explanation: The estimated lifetime risk of experiencing at least one seizure in the general population is approximately 8-10%, indicating its relative commonality.
Ancient cultures, including Mesopotamia and Greece, primarily attributed seizures to brain disorders, a view championed by Hippocrates.
Answer: False
Explanation: Ancient cultures initially attributed seizures to supernatural causes; it was Hippocrates who later challenged these beliefs, proposing a brain disorder etiology.
What is the prognosis for individuals who experience a single provoked seizure due to an acute and reversible cause?
Answer: Generally good, with a low risk of recurrence once the underlying issue is treated.
Explanation: The prognosis for a single provoked seizure from an acute, reversible cause is generally favorable, with a low recurrence risk once the underlying condition is resolved.
What is the approximate risk of experiencing more seizures in the next two years after a first unprovoked seizure?
Answer: 40%
Explanation: Following a first unprovoked seizure, the approximate risk of experiencing additional seizures within the next two years is 40%.
What are the strongest predictors of future seizures after a first unprovoked event?
Answer: Problems identified on an electroencephalogram (EEG) or on imaging of the brain.
Explanation: The strongest predictors of future seizures after a first unprovoked event are abnormalities detected on an electroencephalogram (EEG) or brain imaging.
What was the estimated economic cost of epilepsy in Europe in 2004?
Answer: Approximately €15.5 billion
Explanation: In 2004, the economic cost attributed to epilepsy in Europe was estimated to be approximately €15.5 billion.
When did scientific work on seizure prediction begin?
Answer: 1970s
Explanation: Scientific efforts toward predicting epileptic seizures commenced in the 1970s, with ongoing research in this field.
How has computational neuroscience contributed to understanding seizures?
Answer: By offering a new perspective on their dynamical aspects through computational models.
Explanation: Computational neuroscience has advanced seizure understanding by providing a dynamical perspective through models that elucidate how seizures emerge from neural network interactions.
Who challenged the ancient beliefs that seizures were caused by supernatural forces, proposing they were a disorder of the brain?
Answer: Hippocrates
Explanation: Hippocrates, in the 5th century BCE, challenged ancient supernatural explanations for seizures, positing that epilepsy was a disorder of the brain.
What is the risk of seizure recurrence in adults within five years following a new-onset seizure?
Answer: 35%
Explanation: In adults, the risk of seizure recurrence within five years after a new-onset seizure is 35%, increasing significantly after a second seizure.
What percentage of emergency department visits in the United States are related to seizures?
Answer: 1%
Explanation: Seizures account for approximately 1% of all emergency department visits in the United States, a figure that doubles for pediatric emergency departments.