Paeds SAQs · neurology-neurodisability-and-neuromuscular
Absence, focal and generalised epilepsies — formative SAQs
Formative SAQs on absence, focal and generalised epilepsies: classifying the seizure and the syndrome from the eyewitness account and the EEG, choosing the syndrome-matched first-choice antiseizure medicine, applying the valproate rule in a female adolescent, and recognising the carbamazepine-worsens-absence error.
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SAQ 1 (10)
A seven-year-old girl is brought by her parents after her teacher reported that she has been staring blankly for about ten seconds many times each day, unresponsive to her name, with immediate return to normal and no memory of the events. Her development and examination are normal. An electroencephalogram shows the three-per-second generalised spike-and-wave. [4] [7]
a) Classify the seizure type and name the syndrome, citing the EEG finding that confirms it and the age band that defines it. (3 marks) [4]
b) State the first-choice antiseizure medicine when the child has absence seizures alone, and cite the trial that supports it. Explain why lamotrigine is a weaker first choice in this scenario. (3 marks) [7]
c) The child's mother asks whether carbamazepine, prescribed for the father, could also be used. State the syndrome-medicine rule this question tests and the harm it prevents. (2 marks) [8]
d) Outline the developmental and educational surveillance you would put in place alongside the medicine, naming at least three comorbidities. (2 marks) [4]
References5ShowHide
- [1]Scheffer IE, Berkovic S, Capovilla G, et al. ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia, 2017.PMID 28276062
- [4]Specchio N, Wirrell EC, Scheffer IE, et al. International League Against Epilepsy classification and definition of epilepsy syndromes with onset in childhood: Position paper by the ILAE Task Force on Nosology and Definitions. Epilepsia, 2022.PMID 35503717
- [6]Riney K, Bogacz A, Somerville E, et al. International League Against Epilepsy classification and definition of epilepsy syndromes with onset at a variable age: position statement by the ILAE Task Force on Nosology and Definitions. Epilepsia, 2022.PMID 35503725
- [7]Glauser TA, Cnaan A, Shinnar S, et al. Ethosuximide, valproic acid, and lamotrigine in childhood absence epilepsy. N Engl J Med, 2010.PMID 20200383
- [8]Glauser T, Ben-Menachem E, Bourgeois B, et al. Updated ILAE evidence review of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes. Epilepsia, 2013.PMID 23350722