Seizures: Clinical

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Seizures: Clinical

USMLE® Step 2 questions

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USMLE® Step 2 style questions USMLE

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A 26-year-old woman, gravida 0, para 0, comes to the office for prenatal counseling, as she is planning to start a family. Past medical history is significant for epilepsy, for which she takes valproate. The patient has had 3 lifetime episodes of generalized tonic-clonic seizures, and the last episode was 9 months ago, after which valproate was started. However, the patient is now thinking of discontinuing the drug to avoid any harmful effects on the baby. Vital signs are within normal limits. Physical examination shows no abnormalities. In addition to high dose folic acid supplementation, which of the following is the most appropriate management for this patient?  


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A seizure is a paroxysmal motor, sensory or autonomic event that occurs due to abnormal, excessive and synchronous electrical discharges from neurons in the brain, and usually lasts less than 5 minutes.

If a seizure lasts more than 5 minutes, it’s called status epilepticus.

And the term “convulsion”, refers specifically to motor seizures.

Now, a seizure is different from epilepsy.

Epilepsy is a chronic disease of the brain that predisposes an individual to having recurrent unprovoked seizures; that is seizures without a clear triggering cause.

Epilepsy is typically diagnosed when an individual has two or more unprovoked seizures separated by at least twenty-four hours.

Epilepsy can also be diagnosed when an individual has one seizure and a high likelihood of having another one.

There are many different forms and causes of epilepsy.

Seizures are classified into generalized and focal seizures.

Generalized seizures arise from both cerebral hemispheres at the same time, while focal seizures arise from specific areas in one cerebral hemisphere.

Now, generalized seizures are subclassified into motor and non-motor seizures.

Regardless of the subtype, generalized seizures almost always cause a sudden impairment of consciousness.

Generalized motor seizures include tonic, clonic, tonic-clonic, atonic, and myoclonic seizures.



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