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Temporal lobe epilepsy accounts for what % of all adult patients with epilepsy? 60% The majority of seizures in the intensive care unit are: non convulsive What type of resection is associated with medial temporal sclerosis? Temporal lobectomy The safest AED for pregnant women Lamictal Hypsarrhythmia is a pattern most often associated with Infantile spasms Expressive speech Broca's area Vagus nerve stimulators are approved for use in patients with partial seizures Phenobarbital shows what activity? Beta Which medication is appropriate for treating status epilepticus? Lorazepam Keto diet consists of high fat, low carbohydrates, adequate protein Bolus of Propofol will cause: burst suppression How often should Stimulation assessment be made on patients monitored in the ICU? Daily The greatest utility of CEEG is in the ICU patients with: Unexplained "spells" such as variations in vital signs or twitching
WADA testing, also known as intracarotid amobarbitol procedure is performed for: Language and memory lateralization What less invasive test for language and memory has decreased the number of WADA tests that are being conducted? fMRI PET hypometabolism The intracarotid ambarbital test is used to determine cerebral dominance for: language and memory function WADA is associated with: language function What does PET stand for? Positron Emission Tomography Cerebral angiography prior to intracarotid amobarbital testing is necessary to assess arterial blood flow SPECT stands for: Single Photon Emitted Computed Tomography Which type of procedure is involved during the preoperative diagnostic WADA test? Angiography PET studies in a child with Rasmussen's encephalitis will most likely demonstrate: Widespread hemispheric hypometabolism As part of the pre-surgical work-up, this magnetic source localization is used for spatial and temporal functional mapping of interictal epileptiform discharges MEG **PET studies in a patient with left temporal lobe epilepsy will most likely show Decreased glucose uptake Intracarotid injection of Amobarbital procedures are associated with: ipsilateral hemispheric dysfunction and transient contralateral paralysis The interictal SPECT may show focal Hypoperfusion The goal of cortical stimulation during functional mapping is to:
Hyothalamic Hamartomas are associated with: Gelastic seizures Which type of epilepsy may be confused with psychogenic non epileptic seizures? Frontal lobe epilepsy Lennox- Gastaut Syndrome is associated with what type of seizures? Atypical Absence An effectively known treatment option for Hypothalamic Hamartomas is: Gamma Knife Landau-Kleffner syndrome is associated with what type of symptom? Aphasia The main difference between simple partial and complex partial is: Preservation of consciousness A postictal impairment of function within a discrete region or regions of the brain: Todd's paralysis A surgical treatment for Storage Webers: Hemispherectomy Subacute sclerosis panencephalitis (SSPE) is associated with: Measles According to the National Association of Epilepsy Centers (NAEC), the main difference between a level 3 and a level 4 Epilepsy Center is that a Level 3 center: Is not able to perform intracranial evaluations and is not able to offer complex resective epilepsy surgery Steven-Johnson syndrome is common in critically ill ICU patients. It is a: type of severe skin reaction What is the first defense for minimizing the spread of infection? Handwashing Vector born transmissions occur: Through animals and insects Bacterial spores are destroyed by: sterilization What is the maximum allowable instrument leakage current when recording from a patient with invasive monitoring electrodes?
10 microamps Uncommon and non-traumatic death that occurs suddenly and unexpectedly with epilepsy who were otherwise previously healthy? SUDEP Which precautions should be taken to prevent SUDEP? Monitor cardia and oxygen saturation An appropriate time base for sensory-monitor localization would be 50 sec A 37 year old female is experiencing an auditory aura where she is hearing buzzing in her ears. Which, contacts would most likely show an EEG abnormality? 44 - 45 Basal extra cranial electrodes for recording medial temporal or frontal discharges are placed in the region of the: Foramen ovale A 40 year old is experiencing an epigastric aura, which EEG contacts would most likely show an abnormality 36 - 44 The Rolandic fissure separates the: Precentral and postcentral gyrus Which contacts would show an abnormality if the patient was experiencing expressive aphasia 33 - 34 The common goal of functional mapping is to identify: Sensorimotor and language area What functions as the lowest risk of being affected if a temporal lobectomy is performed in the dominant hemisphere? Supplementary Motor Deficits If a patient was experiencing tongue numbness, which contacts would most likely show an EEG abnormality? 28 - 29 Cortical responses recorded over the primary somatosensory cortex to median SSEPs are: Negative near field responses What is the gold standard test for identifying the motor cortex? Direct cortical stimulation Thrombosis of the anterior cerebral artery is most likely to cause:
Contralateral parietal lobe Wernicke's area lies in: Posterior part of the superior temporal gyrus Foramen ovale electrodes provide intracranial EEG near the: Medial temporal lobe The most common area depth electrodes are inserted in surgical patients: Medial temporal lobe What is a type of phase 1 pre surgical evaluation for refractory focal epilepsy when paired with a video-EEG (VEEG)? Ictal SPECT Sphenoidal electrodes are used to record from what region of the brain? Anterior temporal Functional brain mapping is used to define and confine the excision to non-eloquent cortex Stereotatic frames are used to: place depth electrodes Long term monitoring in the ICU is most helpful for: nonconvulsive status epilepticus Intraoperative cortical mapping is performed for identification of: Eloquent cortex Basal extra cranial electrodes for recording mesial temporal or frontal discharges are placed in the region of the: Foramen ovale Cortical stimulation near the inferior frontal gyrus will most likely result in: Expressive aphasia The purpose of bilateral medial temporal depth electrodes is to: Lateralize hippocampal seizures focus Where are sphenoidal locations used to record epileptiform activity the medial or anterior aspects of the temporal lobe When identifying the central sulcus, what is the time frame that the phase reversal must occur from the original stimulation in order to prove an actual phase reversal? Within 2msec
Which electrodes can best record a focal discharge in Sturge-Weber syndrome? Subocciptial 24 - 48 hour continuous EEG monitoring in the ICU is recommended for diagnosing: Non- convulsive Status What is the correct order for surgical evaluation for epilepsy surgery Seizure, epilepsy diagnosis, medication trials, imaging for pathology, craniotomy, placement of subdural electrodes, EMU surgical resection Responsive neurostimulation, an adjunctive therapy designed for the treatment of epilepsy, has which function? Record, detect and stimulate Phase II of epilepsy surgery is: Subdural electrodes are placed for intracranial monitoring The recommended duration for cEEG in a non-comatose patient suspected of having non-convulsive seizures is: 24 hours Functional mapping of eloquent cortex includes: Motor, sensory and language In patient with intracranial grids, excessive widespread polymorphic slowing with attenuated waveforms raises the question of: Cerebral edema under the grid An appropriate anesthetic regimen for language mapping: Awake with local Relative to P7, the P9 electrode placement is placed: 10% lateral to P T1 and T2 electrode placement: 1 cm superior to 1/3 of the distance from the external eye canthus and the tragus (third closet to tragus) Which electrode from he 10 - 10 system would be useful on a patient with suspected benign rolandic epilepsy CP EEG changes can be seen when cerebral blood flow falls below: 25 - 30ml/100g/minute In the proposed 10 - 10 system what is the designation of the intermediate chain between the fronto polar and frontal leads? Anterior frontal (AF)
What type of material is favored for Stereo EEG electrodes due to its MRI compatible properties? Nickel-Cromium composite Strip and grid electrodes are composed of: Stainless steel or platinum Strip and grid electrodes contacts are typically separated by inter-electrode distances of: 0.5 cm to 1 cm In the 10 - 20 international electrode system, which electrode is placed halfway between Fp2 and O2 when measuring the circumference? T What does OSHA stand for? Occupational Safety and Health Administration (OSHA) What is OSHA's function? Insures an environment of safety for all staff What does CMS stand for? Centers for Medicare and Medicaid Services What is dysgeusia/parageusia? unpleasant perception of taste; causes metallic, salty, foul, or rancid taste What is dystonia? Involuntary sustained muscle contractions, producing twisting or squeezing movement and abnormal postures What is ataxia? the loss of full control of bodily movements What is cataplexy? sudden loss of muscle tone what are the findings on a EEG with Cataplexy? normal What is narcolepsy? A sleep disorder characterized by uncontrollable sleep attacks. The sufferer may lapse directly into REM sleep, often at inopportune times. what are the findings on a EEG with narcolepsy? Early onset REM during sleep what is Wallenbergs Syndrome?
Lesion of vertebral or posterior inferior cerebellar artery (PICA) Injury to the lateral medulla, resulting in tissue ischemia & necrosis, with sensory defecits in: Trunk & extremities on contralateral side of Injury. Face & cranial nerves on the ipsilateral side of the injury. What is dysphagia? difficulty swallowing What is vertigo? dizziness What is nystagmus? involuntary eye movement What is dysarthria? Neurological based speech disorder characterized by abnormal strength, speed, range, steadiness, tone and accuracy. Affects all aspects of speech production, including respiration, phonation, articulation, prosody and resonance. what is ptosis? drooping eyelid what is Horners Syndrome? unilateral combination of: drooping eyelid (ptosis) constricted pupil (miosis) decreased sweating (anhidrosis) eye redness what is Cortical Dysplasia? Intractable Seizures Describe Hyperlexia Fascination with letters or numbers & advanced reading ability. what is Hyperpraphia? Overwhelming urge to write. Associated with temporal lobe epilepsy. what is Hippocampal Sclerosis? Neuronal cell loss & gliosis in hippocampus Specifically the CA- 1 (Cornu Ammonis Area 1) & subiculum. How do you test for Hippocampal sclerosis MRI
According to the international League Against Epilepsy (ILAE) 2015 Guidelines for Status Epilepticus (SE), SE treatment should begin after 5 minutes Digital long term monitoring equipment must be able to record for a minimum of how many hours? 24 Crossing of cables is a troubleshooting technique that helps to eliminate what? 50 - 60 Hz interference During functional mapping, afterdischarges (AD) are more likely to occur with intensity greater than: 10mA What condition does ACNS NOT recommend long term monitoring for neonates? autonomic paroxysms In 58% of neonatal seizures, electro clinical uncoupling occurs after antiseizure medication is given, what would you expect to see on a VEEG? Subclinical seizure continue How would you term: generalized rhythmic delta activity + sharp waves, according to the 2012 ACNS EEG terminology? GRDA+S How many channels are required to provide basic characterization of epileptic EEG events? 16 Monitoring for epilepsy. SI refers to EEG activity that is: stimulus induced Which neonatal population would be a good candidate for long term monitoring? patients that are high risk for acute brain injury What does LPD+R stand for in the 2012 ACNS EEG terminology lateralized periodic discharges + superimposed rhythmic activity What is the best high frequency filter setting during invasive EEG monitoring 150 Hz **LPDs is the new terminology for what EEG term PLEDS Checking the impedance of intracranial electrodes poses a risk to a patient because: alternating current is passed through the electrodes
Per ACNS guidelines, epidural, subdural, intracerebral, forâmen ovale- impedance measurements can be safely performed with currents in the range of: 10nA Impedance measurements can be safely performed in intracranial electrodes only if: performed with low currents in the range of 10nA Continuous EEG is more sensitive for seizure detection than routine EEG in which population of patients? Infants A typical surgical treatment that is considered for Temporal Love Epilepsy Focal resection Seizures characterized by hyper salivation, oral-facial apraxia, and at times facial clinic activity, originate: Frontal operculum Electrical Status Epilepticus in Sleep (ESES) is linked to: Landau-Kleffner syndrome What EEG pattern is a result of the treatment of status epilepticus Burst Suppression the single most definitive localizing feature of the epileptogenic region is Ictal Onset Zone Automatisms are generally associated with activity generated from which lobe? Temporal Lennox-Gastaut syndrome is associated with what type of seizure? Atypical Absence An effectively known treatment option for hypothalamic hamartomas is: Gamma knife EEG is altered by CBF below: 20mL/100g/min The most effectively known treatment for Rasmussen's encephalitis is: Functional hemispherectomy Patients with Ramussen's Encephalitis will most likely present with: Hemiparesis This type of surgical treatment is most beneficial for patients who have epileptic zones arising from or overlapping with eloquent cortex
One way to differentiate rhythmic epileptic seizures from that of rhythmic biologic artifacts is: Identification of postictal slowing ICU patients with a history of hypoxic injury having an EEG characterized by monotonously continuous frontocentral alpha activity that is nonreactive Alpha coma Landau-Kleffner syndroms usually presents with seizure in which lobe? Temporal What should always be monitored to assess the presence of after discharges (ADs) ECoG Changes in cEEG monitoring indicating cerebral ischemia: Decreased fast activity and increased slowing Periodic, rhythmic, or octal-appearing discharges that are consistently induced by alerting stimuli: SIRPIDS Accurate evaluation of language interruption during stimulation must have the absence of: Afterdischarges (ADs}) SI or SIRPIDS patterns are induced by stimulus Afterdischarges (ADs) are considered what: Periodic or continuous epileptiform discharges The typical latency for somatosensory cortical potentials to upper extremity stimulation is: 20 sec Which polarity and electrode signal generates from the motor cortex when doing evoked potential phase reversal mapping? Positive polarity, P The best trend for evaluation of ischemia is: alpha variability Triphasic waves are seen when a patient has: metabolic encephalopathy Subarachnoid Hemorrhage (SAH) causes EEG what? slowing Rhythmic occipital delta may commonly be seen in:
Children Per ACNS Guidelines, an important aspect of montage design for LTME is to clearly separate activity from the Basal temporal and 10/20 cortical derivations Based on the 2015 American Red Cross Guidelines for CPR, compression rate for adults is 100/min Based on the 2015 American Red Cross Guidelines for CPR, compression depth for adults is at least 2" Based on the 2015 American Red Cross Guidelines for CPR, compression to breaths ratio for adults is: 30 to 2 Olfactory hallucinations are not associated with: inferior occipital lobe Ictal weeping and pelvic thrusting are characteristics of: psychogenic seizures Hypothalamic Harmaomas are associated with: Gelastic seizures Patient with microcephaly presents with flapping hand movements, frequent laughing or unusual smiling and an unusual happy demeanor what syndrome might they have? Anglelman syndrome Hypsarrhythmia is a pattern most often associated with: Infantile spasms A patient who experiences epigastric rising followed by a 10 second oral and/or manual automatisms, is unable to respond to verbal commands and has postictal confusion for several minutes most likely indicates: Complex partial The main difference between simple and partial and complex partial is: preservation of consciousness What is the most common sign of temporal lobe seizures? contralateral dystonia Bicycling movements are most often seen in adult seizures arising from the: frontal lobe Complex automatisms arise from: Medial temporal
Anterior temporal spikes in children usually represents: an identifiable structural lesion What best describes the low voltage, fast frequency pattern that follows electrical stimulation to the cortex afterdischarges subarachnoid hemorrhage causes (SAH) EEG slowing what should always be monitored to access the presence of afterdischargs (ADs) ECog Periodic, rhythmic or ictal-appearing discharges that are constantly induced by alerting stimuli. SIRPPIDS The EEG findings in this sample are suggestive of: moderate-severe encephalopathy The typical latency for somatosensory cortical potentials to upper extremity stimulation is 20 sec Accurate evaluation of language interruption during stimulation must have the absence of Afterdischarges (ADs) the best trend for evaluation of ischemeia is alpha variability One way to differentiate rhythmic epileptic seizure from that of rhythmic biologic artifact is: identification of postictal slowing Which polarity and electrode signal generates from the motor Cortex when doing evoked potential phase reversal mapping positive polarity- P Triphasic waves are associated with: metabolic encephalopathy In comparison with to surface EEG, recording from ECoG will present Faster frequencies and higher amplitude Landau-kleffner syndrome usually presents with seizures located where temporal lobe seizures SI or SIRPIDS patterns are induced by
stimulus Changs in cEEG monitoring indicating cerebral ischemia: Decreased fast activity and increased slowing ICU patients with a history of hypoxic injury having an EEG characterized by monotonously continuous frontocentral alpha activity that is nonreactive Alpha coma what is criteria for sudden unexpected death in epilepsy (SUDEP) no explained caused Based on the 2015 American Red Cross Guidelines for CPR, compression depth for adults is at least 2" The main difference between simple partial and complex partial is preservation of consciousness Bicycling movements are most often seen in adult seizures arising from the frontal lobe Complex automatisms Mesial temporal Hypothalamic Hamartomas are associated with Gelastic seizures A patient who experiences epigastric rising followed by a 10 second oral and/or manual automatisms, is unable to respond to verbal commands and has postictal confusion for several minutes most likely indicates: complex partial In a patient with persistent coma or unexplained neurological deterioration, the most useful test is: continuous EEG monitoring Ictal weeping and pelvic thrusting may indicate Non-epileptic events/ psychogenic seizures Most common sign of temporal lobe seizures contralateral dystonia Patient with microcephaly present with flapping hand movements, frequent laughing or unusual smiling and an unusual happ demeanor Angelman syndrome Olfactory hallucinations are not associated with the:
