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Continuum Postreading Test 28(2) April 2022 (Epilepsy)

Continuum Postreading Test 28(2) April 2022 (Epilepsy)i

Learning Objectives

Upon completion of this Continuum: Lifelong Learning in Neurology Epilepsy issue, participants will be able to:
  • Distinguish new-onset seizures from nonepileptic events and choose comprehensive but cost-effective investigations for patients with new-onset seizures, taking into account epilepsy type, syndrome, comorbidities, and probable etiology, to optimize treatment and clarify long-term prognosis
  • Describe the essential features involved in recording and interpreting EEG and recognize classic EEG findings in patients with chronic epilepsy, as well as the common EEG patterns found in critically ill patients with acute neurologic disease
  • Describe the principal structural and functional imaging modalities used in the diagnosis and evaluation of patients with epilepsy and discuss the indications for their use at different stages of an epilepsy evaluation
  • Discuss the clinical and electrographic features of epilepsy syndromes thought to occur primarily due to genetic factors and the known genetic factors associated with specific phenotypes
  • Identify clinical features suggesting an autoimmune etiology of the cause of seizures, use clinical scoring systems to aid diagnosis in autoimmune seizure disorders, and initiate first-line treatments in patients with acute symptomatic seizures secondary to autoimmune encephalitis
  • Describe best practices in the management of women with epilepsy, incorporating up-to-date evidence in sex- and gender-specific issues including transgender care, catamenial epilepsy, contraception, pregnancy, infertility, and aging
  • Discuss the basic concepts of childhood-onset epilepsy and the diagnostic and therapeutic aspects and specific considerations in this age group
  • Discuss psychiatric and cognitive comorbidities of epilepsy over the lifespan and identify opportunities to improve the quality of care of patients with epilepsy
  • Describe a general evidence-based approach to the use of antiseizure medications in the treatment of focal and generalized epilepsies
  • Discuss the specrum of efficacy, clinical pharmacology, and modes for use for individual antiseizure medications
  • Define drug-resistant epilepsy and discuss current diagnostic tools for presurgical evaluation and current evidence for surgical epilepsy therapies for patients with drug-resistant epilepsy
  • Integrate the presented process of management of status epilepticus into existing standard operating procedures, evaluate the potential risks and benefits of treatments, and create a care plan for patients with status epilepticus

Core Competencies

This Continuum: Lifelong Learning in Neurology Epilepsy issue covers the following core competencies:
  • Patient Care
  • Medical Knowledge
  • Practice-Based Learning and Improvement
  • Interpersonal and Communication Skills
  • Professionalism
  • Systems-Based Practice

Contributorsa

Nathalie Jetté, MD, MSc, FRCPC, CSCN(EEG), FAAN, FAES, FANA, Guest Editor
Professor of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York

Relationship Disclosure: Dr Jetté has received personal compensation in the range of $500 to $4999 for serving as an Associate Editor for Epilepsia. The institution of Dr Jette has received research support from the American Epilepsy Society, the National Institutes of Health, the NORSE Institute and the Patient-Centered Outcomes Research Institute.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Jetté reports no disclosure.

Bassel W. Abou-Khalil, MD, FAAN
Professor of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee

Relationship Disclosure: Dr Abou-Khalil has served on the editorial board of Clinical Neurophysiology. The institution of Dr Abou-Khalil has received research support from Biogen, Cerevel Therapeutics, Human Epilepsy Project, Otsuka America Pharmaceutical, Inc, SK-Pharma, Sunovion Pharmaceuticals Inc, UCB SA, and Xenon.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Abou-Khalil discusses the unlabeled/investigational use of cannabidiol and clobazam for the treatment of focal-onset seizures, gabapentin for the treatment of headache and sleep disorders, lamotrigine as a first-line treatment for epilepsy, perampanel for myoclonus, primidone for the treatment of essential tremor, valproate for the treatment of generalized myoclonic and generalized tonic-clonic seizures, and zonisamide as initial monotherapy for epilepsy.

Francesco Brigo, MD
Department of Neurology, Hospital of Merano, Merano-Meran, Italy

Relationship Disclosure: Dr Brigo reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Brigo reports no disclosure.

Jeffrey Britton, MD, FAAN
Chair, Division of Epilepsy; Professor of Neurology, Mayo Clinic, Rochester, Minnesota

Relationship Disclosure: Dr Britton has received personal compensation in the range of $0 to $499 for serving as an online course instructor for the American Clinical Neurophysiology Society.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Britton discusses the unlabeled/investigational use of azathioprine, cyclophosphamide, IVIg, methylprednisolone, mycophenolate mofetil, prednisone, and rituximab for the treatment of autoimmune encephalitis.

Esther Bui, MD, FRCP(C)
Assistant Professor of Neurology, University of Toronto; Epilepsy Fellowship Director; Women’s Neurology Fellowship Director; Director of Education–Canadian League Against Epilepsy, Toronto, Ontario, Canada

Relationship Disclosure: Dr Bui reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Bui discusses the unlabeled/investigational use of acetazolamide, clobazam, and hormonal therapies for the treatment of catamenial epilepsy.

Honor Coleman, MPsych, PhD
Clinical Neuropsychologist, Alfred Health; Lecturer, University of Melbourne, Melbourne, Victoria, Australia

Relationship Disclosure: Relationship Disclosure: Dr Coleman has received personal compensation for serving as a research lead for the Epilepsy Foundation of Australia.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Coleman reports no disclosure.

Judith Helen Cross, MBChB, PhD
Developmental Neurosciences, University College London Great Ormond Street Institute of Child Health; Department of Neurology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom

Relationship Disclosure: Dr Cross holds an endowed chair at the University College London Great Ormond Street Institute of Child Health. The institution of Dr Cross has received support from Biocodex, the Engineering and Physical Sciences Research Council, Epilepsy Research UK, Great Ormond Street Hospital Charity, GW Pharmaceuticals plc, Marinius Pharmaceuticals, Inc, the National Institute of Health Research Great Ormond Street Hospital Biomedical Research Centre, Nutricia, Vitafl o (International) Limited, the Waterloo Foundation, and Zogenix.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Cross discusses the unlabeled/investigational use of memantine for the treatment of GRIN2A-related epilepsies, quinidine for the treatment of KCNT1-related epilepsies, and radiprodil for the treatment of GRIN2B-related epilepsies.

George W. Culler IV, MD
Assistant Professor of Neurology, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire

Relationship Disclosure: Dr Culler reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Culler discusses the unlabeled/investigational use of neurostimulation for the treatment of refractory genetic/idiopathic generalized epilepsy.

Lisa Gillinder, MBBS, FRACP
Service Director, Mater Advanced Epilepsy Unit, Mater Hospital, South Brisbane, Queensland, Australia

Relationship Disclosure: Dr Gillinder reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Gillinder discusses the unlabeled/investigational use of azathioprine, cyclophosphamide, IVIg, methylprednisolone, mycophenolate mofetil, prednisone, and rituximab for the treatment of autoimmune encephalitis.

Maria Gogou, MD, PhD
Department of Neurology, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, United Kingdom

Relationship Disclosure: Dr Gogou reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Gogou discusses the unlabeled/investigational use of memantine for the treatment of GRIN2A-related epilepsies, quinidine for the treatment of KCNT1-related epilepsies, and radiprodil for the treatment of GRIN2B-related epilepsies.

Barbara C. Jobst, MD, Dr Med, FAAN
Chair and Professor of Neurology, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire

Relationship Disclosure: Dr Jobst has received personal compensation of $20,000 for serving as an Associate Editor on Neurology. The institution of Dr Jobst has received research support from the American Epilepsy Society, the Centers for Disease Control and Prevention, the Department of Defense, the Epilepsy Foundation, Harvard Pilgrim Health Care, Inc, the National Institutes of Health, and NeuroPace, Inc.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Jobst discusses the unlabeled/investigational use of neurostimulation for the treatment of refractory genetic/idiopathic generalized epilepsy.

Markus Leitinger, MD, MSc
Privatdozent, Department of Neurology, Neurointensive Care, and Neurorehabilitation, Christian Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience; Neuroscience Institute, Christian Doppler University Hospital Salzburg, Centre for Cognitive Neuroscience, Salzburg

Relationship Disclosure: Dr Leitinger reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Leitinger discusses the unlabeled/investigational use of antiseizure medications for the treatment of status epilepticus.

Anthony Marson, MBChB, MD, FRCP
Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, United Kingdom

Relationship Disclosure: Dr Marson has received publishing royalties from Oxford University Press.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Marson reports no disclosure.

Marco Mula, MD, PhD, FRCP, FEAN
Consultant in Neurology and Epileptology, Atkinson Morley Regional Neuroscience Centre, St George’s University Hospital; Reader in Neurology, Institute of Medical and Biomedical Education, St George’s University of London, London, United Kingdom

Relationship Disclosure: Dr Mula has received personal compensation in the range of $500 to $4999 for serving on a speakers bureau for Eisai Co, Ltd, and UCB, Inc, and for serving as an Associate Editor for Epilepsy & Behavior; has received publishing royalties from Elsevier and Springer Publishing Company; and has a compensated relationship with the Korean League Against Epilepsy and the Philippine League Against Epilepsy.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Mula reports no disclosure.

Kenneth A. Myers, MD, PhD, FRCPC, CSCN(EEG)
Assistant Professor, Department of Pediatrics, Division of Child Neurology, McGill University; Junior Scientist, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada

Relationship Disclosure: Dr Myers has received personal compensation in the range of $500 to $4999 for serving as an academic writer with Springer Publishing Company. The institution of Dr Myers has received research support from Dravet Canada, Fonds de recherche du Québec, Koolen-de Vries Syndrome Foundation, The Liam Foundation, and the Savoy Foundation.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Myers discusses the unlabeled/investigational use of clobazam for the treatment of forms of epilepsy other than Lennox-Gastaut syndrome and quinidine for the treatment of epilepsy due to KCNT1 pathogenic variants.

Dang K. Nguyen, MD, PhD, FRCPC Neurologist, Centre hospitalier de l’Université de Montréal; Professor (Neuroscience), Université de Montréal, Montreal, Quebec, Canada

Relationship Disclosure: Dr Nguyen reports no disclosure.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Nguyen reports no disclosure.

William O. Tatum IV, DO, FAAN, FACNS, FAES
Professor of Neurology, Mayo Clinic College of Medicine & Science; Chief, Division of Epilepsy, Mayo Clinic, Jacksonville, Florida

Relationship Disclosure: Dr Tatum has received personal compensation in the range of $500 to $4999 for serving as an Editor-in-Chief for Epilepsy & Behavior Reports and as an expert witness for a defense law firm on behalf of a patient with epilepsy with funds donated to the Epilepsy Foundation of America; has received personal compensation in the range of $10,000 to $49,999 for serving as a consultant for BioSerenity, Holberg EEG AS, Neurelis, Inc, Zimmer Biomet; and has received publishing royalties from Demos and Springer Publishers. The institution of Dr Tatum has received research support from Cerevel Therapeutics, Engage Pharma, Esai Inc, LivaNova PLC, the Mayo Clinic, Medtronic, and Xenon.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Tatum reports no disclosure.

Eugen Trinka, MD, MSc, FRCP
Professor, Department of Neurology, Neurointensive Care, and Neurorehabilitation, Christian Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, Salzburg; Neuroscience Institute, Christian Doppler University Hospital Salzburg, Centre for Cognitive Neuroscience, Salzburg; Department of Public Health, Health Services Research and Health Technology Assessment, UMIT–University for Health Sciences, Medical Informatics and Technology, Hall in Tirol; Karl Landsteiner Institute for Neurorehabilitation and Space Neurology, Salzburg, Austria

Relationship Disclosure: Dr Trinka has received personal compensation in the range of $500 to $4999 for serving as a Chief Executive Officer of Neuroconsult Ges.m.b.H and for serving as a consultant for Arvelle Therapeutics, Bial, Biogen, Boehringer Ingelheim International GmbH, Eisai Co, Ltd, Ever Pharma, GlaxoSmithKline plc, GW Pharmaceuticals plc, LivaNova PLC, Marinus Pharmaceuticals, Inc, Medtronic, NewBridge Pharmaceuticals, Novartis AG, Sandoz International GmbH, Sanofi, Sunovion Pharmaceuticals Inc, Takeda Pharmaceutical Company Limited, and UCB, Inc, and has received research support from the Austrian Science Fund (FWF), Bayer AG, Biogen, Eisai Co, Ltd, the European Union, GlaxoSmithKline plc, Novartis AG, Oesterreichische Nationalbank, Red Bull, and UCB, Inc.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Trinka discusses the unlabeled/investigational use of antiseizure medications for the treatment of status epilepticus.

Sarah J. Wilson, PhD, FAHMS, FASSA
Professor of Clinical Neuropsychology and Pro Vice-Chancellor (Student Life), University of Melbourne, Victoria, Australia

Relationship Disclosure: Dr Wilson has received personal compensation in the range of $0 to $499 for serving on a speakers bureau for Pretola Global Health Consulting Limited. The institution of Dr Wilson has received research support from the Austin Medical Research Foundation, Australian Research Council, Australian Government National Health and Medical Research Council, and the Epilepsy Foundation.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Wilson reports no disclosure.

Elaine Wirrell, MD, FRCP(C), FAAN
Professor of Neurology, Divisions of Child and Adolescent Neurology and Epilepsy, Department of Neurology, Mayo Clinic, Rochester, Minnesota

Relationship Disclosure: Dr Wirrell has received personal compensation in the range of $500 to $4999 for serving as a Consultant for BioMarin and Eisai Co, Ltd, and for serving on a scientific advisory or data safety monitoring board for Amicus Therapeutics, Inc, Encoded Therapeutics, Inc, and Neurocrine Biosciences, Inc, and has received publishing royalties from UpToDate, Inc.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Wirrell reports no disclosure.

Self-Assessment and CME Test Writers

Douglas J. Gelb, MD, PhD, FAAN
Professor of Neurology, University of Michigan, Ann Arbor, Michigan

Relationship Disclosure: Dr Gelb has received publishing royalties from MedLink, LLC, Oxford University Press, and UpToDate, Inc. Dr Gelb has received personal compensation in the range of $500 to $4999 for serving as a multiple-choice question writer for Continuum.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Gelb reports no disclosure.

James W. M. Owens Jr, MD, PhD
Associate Professor of Neurology, Adjunct Associate Professor of Pediatrics, University of Washington School of Medicine, Seattle, Washington

Relationship Disclosure: Dr Owens has received personal compensation in the range of $500 to $4999 for serving as an Associate Editor for Continuing Medical Education and as a question writer for the American Academy of Neurology. Dr Owens has a noncompensated relationship as a member of the Accreditation Council with the United Council for Neurologic Subspecialties.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Owens reports no disclosure.

AAll relevant financial relationships have been mitigated.

Accreditation

Accreditation Statement: The American Academy of Neurology Institute is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide CME for physicians. For information on Continuum Audio CME, please visitcontinuum.audio-digest.org.

AMA Credit: The American Academy of Neurology Institute designates this enduring material for a maximum of 20 AMA PRA Category1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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