If you are looking for a quick reference table for all types of epilepsy, clinical features, EEG findings and First line drug this is the post that you have to save to your device.  This is followed by a video tutorial and then 5 MCQ with long options mimicking what happens in entrance exams like NEET PG and INICET examinations.

Types of Epilepsy

Now you can go practical aspects and watch simulation from the following videos. This will help you understand the nuances of this table relatively better. https://www.youtube.com/watch?v=s4rxG1Ho8L8

Here are 5 NEET PG/INI-CET–style clinical questions on Epilepsy, with long and tricky options, followed by correct answers and brief explanations:

Question 1

A 25-year-old male presents with a history of recurrent seizures characterized by sudden behavioral arrest, lip-smacking, and fumbling movements of the hands lasting about 1–2 minutes, followed by confusion and disorientation. MRI reveals hippocampal sclerosis. Which of the following is the most appropriate treatment option for long-term management?

A. Continue valproate and phenytoin combination therapy with periodic dose adjustments and monitor for hepatic and hematologic toxicity
B. Add clobazam to ongoing carbamazepine therapy to achieve better seizure control without planning for surgical options
C. Refer for anterior temporal lobectomy after appropriate video EEG and neuroimaging evaluation, as drug resistance is likely
D. Switch to levetiracetam monotherapy and monitor response for 12 months before considering invasive procedures

Correct Answer: C. Refer for anterior temporal lobectomy after appropriate video EEG and neuroimaging evaluation, as drug resistance is likely

Explanation: The patient has features of mesial temporal lobe epilepsy (MTLE), likely drug-resistant, especially with hippocampal sclerosis. Surgery (anterior temporal lobectomy) is the treatment of choice in refractory cases.

Question 2

A 7-year-old child is brought to the clinic with a history of frequent brief episodes where she stops talking, stares into space for a few seconds, and then resumes activity as if nothing happened. EEG shows 3 Hz spike-and-wave discharges. Which of the following is the most appropriate first-line treatment?

A. Carbamazepine, which is highly effective for generalized and focal seizures including absence
B. Phenytoin, as it has broad-spectrum activity with minimal behavioral side effects in children
C. Ethosuximide, as it is particularly effective for absence seizures and well tolerated
D. Lamotrigine, which is preferred over valproate due to its favorable safety profile in young children

Correct Answer: C. Ethosuximide, as it is particularly effective for absence seizures and well tolerated

Explanation: Typical absence seizures respond best to ethosuximide. Valproate is also effective but used when generalized seizures coexist. Carbamazepine can worsen absence seizures.

 Question 3

A 60-year-old male with a history of focal seizures develops a generalized tonic-clonic seizure in the emergency department that continues for over 5 minutes without regaining consciousness. IV access is available. What is the next best step in management?

A. Administer IV phenytoin loading dose and wait 20 minutes before considering benzodiazepines
Immediate administration of IV lorazepam followed by IV phenytoin to abort status epilepticus
C. Secure airway and give IV mannitol before starting anti-epileptic treatment to prevent raised ICP
D. Administer oral levetiracetam through nasogastric tube if IV lorazepam is unavailable

 Correct Answer: B. Immediate administration of IV lorazepam followed by IV phenytoin to abort status epilepticus

Explanation: Generalized convulsive status epilepticus (GCSE) requires benzodiazepines first (IV lorazepam), followed by a long-acting agent like phenytoin or valproate.

Question 4

A 30-year-old woman with epilepsy is planning pregnancy. She is currently on valproate monotherapy with good seizure control. What is the best strategy in this case?

A. Continue valproate and add folic acid 5 mg/day to reduce neural tube defect risk
B. Switch to lamotrigine before conception as it has a lower teratogenic risk and is effective
C. Stop all antiepileptic drugs before conception and monitor EEG to reduce fetal risk
D. Add carbamazepine to valproate to lower the required dose of each and minimize side effects

Correct Answer: B. Switch to lamotrigine before conception as it has a lower teratogenic risk and is effective

Explanation: Valproate is highly teratogenic, especially causing neural tube defects. Lamotrigine is safer in pregnancy. Ideally, switch medications before conception.

 Question 5

A 17-year-old male presents with early morning myoclonic jerks, especially soon after waking, and occasional generalized tonic-clonic seizures. He has no focal neurological deficits, and EEG shows generalized polyspike-and-wave discharges. Which of the following is the most likely diagnosis?

A. Juvenile myoclonic epilepsy, a generalized epilepsy syndrome with excellent prognosis and good response to valproate
B. Lennox-Gastaut syndrome, a severe childhood-onset epilepsy with tonic seizures, cognitive decline, and poor prognosis
C. Benign rolandic epilepsy, a childhood epilepsy with focal seizures involving the face and normal development
D. Progressive myoclonic epilepsy, characterized by worsening neurological function and resistance to therapy

Correct Answer: A. Juvenile myoclonic epilepsy, a generalized epilepsy syndrome with excellent prognosis and good response to valproate

Explanation: Classic presentation of JME—adolescent onset, morning myoclonic jerks, and occasional GTCS. Valproate is first-line, though alternatives like levetiracetam are preferred in females due to teratogenicity.