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Adult absence semiology misinterpreted as mesial temporal lobe epilepsy Volume 16, numéro 4, December 2014

TEST YOURSELF


(1) Which feature BEST separates temporal lobe seizures from juvenile absences?
A. Impaired responsiveness
B. Staring episodes
C. Automatisms
D. Post-ictal state
E. Abnormal brain MRI


(2) Which antiepileptic drug would be the best choice for a female patient with unclassified seizures that manifest as a blank stare in addition to generalized tonic-clonic seizures?
A. Carbamazepine
B. Primidone
C. Phenytoin
D. Lacosamide
E. Lamotrigine

 

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Answers


(1) D. Episodes of staring, variable degrees and durations of impaired responsiveness, and simple automatisms may all occur with both absence and temporal lobe seizures. An abnormal brain MRI may or may not be associated with causative or incidental epilepsy. The post-ictal state is a characteristic feature of focal seizures when it is present and does not occur after absence seizures.

 

(2) E. Primidone may have some efficacy when seizures are unclassified, but the potential for side-effects outweighs the risks when compared with other medications. Lacosamide has not been yet proven to be a broad-spectrum AED in appropriate controlled clinical trials. Phenytoin and carbamazepine may exacerbate generalized absence seizures. Lamotrigine has demonstrated efficacy in addition to valproate and ethosuximide, but only lamotrigine and valproate have efficacy against generalized tonic-clonic seizures.

 

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