Seizures

1. Name the two major categories of seizures.		G7 p.394:60mm
a. g_____	generalized
b. p_____	partial
2. List the six major types of primary generalized seizures. Hint: magcat		G7 p.394:60mm
a. m_____	myoclonic
b. a_____	atonic (drop attacks)
c. g_____	generalized (grand mal)
d. c_____	clonic
e. a_____	absence (petit mal)
f. t_____	tonic
3. What are the major differences between primary generalized and partial seizures?		G7 p.394:60mm
a. primary generalized
i. areas involved	bilateral and symmetrical
ii. percent of seizures	40% of all seizures
iii. consciousness	loss of consciousness at onset
iv. significance	does not suggest structural lesion
b. partial
i. areas involved	one hemisphere
ii. percent of seizures	57% of all seizures
iii. consciousness	no loss of consciousness at onset
iv. significance	suggests structural lesion
4. Matching. Match the type of seizure with its listed characteristic(s). More than one may apply. Characteristic: 3% of seizures; 40% of seizures; 57% of seizures; consciousness lost from onset; tonic clonic motor activity; involves both hemispheres; no postictal confusion; spike and wave exactly 3/s; represents a structural lesion Seizure:		G7 p.394:70mm
a. generalized	, , ,
b. partial	,
c. unclassified
d. absence	,
5. The main difference is that simple partial seizures have		G7 p.394:120mm
a. _____ _____of_____ and complex partial seizures have	no loss of consciousness
b. _____of_____.	loss of consciousness
6. Briefly describe the following characteristics of absence seizures:		G7 p.395:70mm
a. motor involvement_____	absent
b. postictal state_____	absent
c. loss of consciousness_____	absent
d. characteristic electroencephalography (EEG) of_____	abnormal EEG 3/s spike and wave
e. effect of hyperventilation_____	induces seizures
7. Briefly describe the following characteristics of uncinate seizures:		G7 p.395:100mm
a. arise from _____-_____	uncus-hippocampus
b. produce hallucinations of_____	odor
c. kakosmia is perception of_____ where none exist	bad odors
8. Complete the following about seizures:		G7 p.395:120mm
a. What is the most common cause of intractable temporal lobe epilepsy?	mesial temporal sclerosis
b. due to_____	loss of cells in hippocampus
c. treated by_____	medication till refractory then surgery
9. Name the rare syndrome with the following features: childhood onset, drop attacks, treatment by valproic acid, and surgery by corpus callosotomy.	Lennox-Gastaut syndrome	G7 p.396:45mm
10. Describe Todd paralysis.		G7 p.396:60mm
a. occurs after_____	seizure
b. causes_____	weakness
c. resolves with_____	time
d. another name for it is_____	postictal paralysis
11. Name factors that lower seizure threshold. Hint: seizure history		G7 p.396:90mm
i. s_____	stroke
ii. e_____	elevated temperature, fever
iii. i_____ infection, intoxication
iv. z_____	“zzzzs” lost (sleep deprivation, fatigue)
v. u_____	uremia
vi. r_____	repeated seizures (kindling)
vii. e_____	electrolyte imbalance pH, Mg++, low NA, high Ca++
viii. h_____	hyperventilation, hyponatremia, hypoglycemia, hypercalcemia
ix. i_____	ischemia
x. s_____	stimulation (photic)
xi. t_____	trauma, tumor
xii. o_____	opioids
xiii. r_____	removal or withdrawal of alcohol or antiseizure meds suddenly
xiv. y_____	youth (birth asphysia, congenital central nervous system [CNS] abnormalities)

Special Types of Seizures

12. Complete the following about special types of seizures:		G7 p.396:150mm
a. Incidence of new-onset seizures per 100,000 person years is_____.	44 per 100,000
b. % that recur	27%
c. If all studies are normal can you release the patient from your care?	no
d. What should you do?	repeat CT or MRI
e. For how long?	6 months and again in 1 or 2 years	G7 p.397:140mm
13. What are the two categories of posttraumatic seizures?		G7 p.398:48mm
a. _____ within _____ days	early within 7 days after trauma
b. _____ beyond _____ days	late beyond 7 days after trauma
14. Complete the following about special types of seizures:		G7 p.398:55mm
a. True or False. Anticonvulsants prevent early posttraumatic seizures and reduce the frequency of late posttraumatic seizures.	false (Anticonvulsants have been shown to reduce the risk of early posttraumatic seizures, up to 1 week, but they do not reduce the frequency of late posttraumatic seizures.)
b. Therefore, you should stop antiepileptic drugs (AEDs) after _____.	1 week
15. Incidence of seizures in early posttrauma period (1 to 7 days) is		G7 p.398:70mm
a. _____% in severe head injuries	30%
b. _____% in mild to moderate head injuries	1%
16. Incidence of late seizures (greater than 7 days) is _____% over a 2-year period.	10 to 13%	G7 p.398:90mm
17. True or False. The incidence of posttraumatic seizures is higher with closed head injuries than with penetrating head injuries.	false (The incidence is higher with penetrating head injuries; occurs in 50% of cases followed 15 years.)	G7 p.398:120mm
18. Answer the following concerning posttraumatic seizures:		G7 p.398:140mm
a. Is there any treatment that reduces the
i. frequency of late posttraumatic seizures?	no
ii. frequency of early posttraumatic seizures?	yes
iii. by how much?	75%
b. What may reduce the frequency?	antiseizure medication
i. To be used for how long?	1 week
ii. Are there any exceptions to that length of time?	yes
iii. What are they?	penetrating wound, craniotomy, prior seizures
c. What do we mean when we say late posttraumatic seizure (PTS)?	1 week after the trauma
19. What occurs with long-term Dilantin use?	adverse cognitive effects	G7 p.398:150mm
20. True or False. Antiepileptic drugs have been shown to		G7 p.398:160mm
a. impede epileptogenesis	false
b. reduce the incidence of late posttraumatic seizures	false
c. improve outcome by reducing posttraumatic seizures	false
d. reduce seizure recurrence after epilepsy has developed	true
e. all of the above	false
21. True or False. Indications for AEDs after trauma include		G7 p.399:15mm
a. alcohol abuse	true
b. computed tomographic (CT) scan shows blood in brain	true
c. Glasgow Coma Scale (GCS) score below 10	true
d. seizure after injury	true
22. Using AEDs after head trauma can result in_____ in early posttraumatic seizures.	reduction	G7 p.399:15mm
23. True or False. In appropriate patients, antiepileptic drugs should be tapered off after		G7 p.399:50mm
a. 24 hours	false
b. 48 hours	false
c. 7 days	true
d. 14 days	false
e. 6 months	false
24. True or False. Physicians should continue antiepileptic drugs longer than 1 week in patients with		G7 p.399:55mm
a. penetrating brain injury	true
b. development of late posttraumatic seizures	true
c. prior seizure history	true
d. undergoing craniotomy	true
25. True or False. Ethanol withdrawal seizures are seen in 33% of habitual drinkers within_____ of stopping or reducing ethanol intake.		G7 p.399:95mm
a. 1 to 2 hours	false
b. 3 to 5 days	false
c. 7 to 30 hours	true
d. 1 to 2 weeks	false
26. Answer the following about alcohol withdrawal patients:		G7 p.399:105mm
a. What occurs first: delirium tremens (DTs) or seizures?	seizures
b. Risk of onset of seizures lasts for _____.	48 hours (2 days)
c. Risk of onset of DTs lasts for_____.	96 hours (4 days)	G7 p.274:30mm
d. Risk persists for _____ days.	1 to 3 days	G7 p.275:20mm
e. Are AEDs recommended?
i. for prophylaxis?	yes, as prophylaxis only
ii. for treatment?	no (Because seizure is usually single, brief, and self-limited, AEDs are not indicated once seizure has occurred.)
27. True or False. Patients with ethanol withdrawal seizures should receive long-term antiepileptic drugs if they have		G7 p.399:175mm
a. history of prior ethanol withdrawal seizures	true
b. recurrent seizures	true
c. history of prior seizure disorder unrelated to ethanol	true
d. risk factors for seizures (e.g., subdural hematoma)	true

Nonepileptic Seizures

28. Answer the following about nonepileptic seizures (NES):		G7 p.400:32mm
a. aka pse_____	pseudoseizures
b. aka psy_____	psychogenic
c. True or False
i. They are real events.	true
ii. They may not be under voluntary control.	true
iii. They are helped by AEDs.	false
iv. Up to 50% of these patients also have legitimate seizures at times.	true
29. What are the features suggestive of nonepileptic seizures (NES)?		G7 p.401:75mm
a. This feature is 90% specific for NES: _____of the_____	arching; back
b. Another feature that is very specific is w_____	weeping
c. Forced eye_____	closing
d. Bilateral shaking with preserved _____	awareness
e. Variable _____ _____	seizure types
f. Clonic UE or LE movements that are _____ _____ _____	out of phase
g. Pelvic_____	thrust
h. Altered by_____	distraction
30. A feature strongly suggestive of epileptic seizure is l_____ t_____ l_____.	lateral tongue laceration	G7 p.401:160mm
31. True or False. Nonepileptic seizures (NES) can be detected with the following:		G7 p.401:135mm
a. out of phase (arrhythmic) motor activity	true
b. lack of vocalization at start of seizure	true
c. lack of postictal confusion or lethargy	true
d. absence of urinary incontinence	false (Absence of urinary incontinence may be the case in both epileptic seizures and NES and therefore can’t be used to differentiate.)
e. suggestible or inducible seizures	true
32. True or False. Which serum hormone may be used to confirm a true seizure versus nonepileptic seizures (psychogenic seizures)?		G7 p.401:165mm
a. TSH	false
b. ACTH	false
c. Cortisol	false
d. GH	false
e. prolactin	true
33. To use this test, blood must be drawn promptly because peak levels of the hormone are reached in_____.	20 minutes	G7 p.401:165mm
34. True or False. The most common type of seizure is		G7 p.402:85mm
a. ethanol withdrawal	false
b. tumor induced	false
c. posttraumatic	false
d. febrile	true
e. epileptic	false
35. True or False. Antiepileptic drugs that prevent afebrile seizures after a febrile seizure include		G7 p.402:115mm
a. phenobarbital	false
b. phenytoin	false
c. valproic acid	false
d. carbamazepine	false
e. none of the above	true (Diazepam may be helpful during period of fever.)

Status Epilepticus

36. True or False. Status epilepticus is defined as more than 5 minutes of		G7 p.402:178mm
a. continuous seizures	true
b. multiple seizures without fully recovering consciousness	true
c. persistent seizure despite 1 st and 2nd line AED	true
37. Complete the following about status epilepticus (SE):		G7 p.403:170mm
a. The mean duration of status is_____ hours.	1.5
b. The mortality from SE is_____%.	1 to 2%
c. The mortality from underlying acute event is_____ %.	10 to 12%
d. Irreversible changes from repetitive electrical discharges begin to appear in neurons as early as_____ minutes.	20
e. Cell death may occur after_____ minutes.	60
38. For a patient in status epilepticus, the workup includes the following: Hint: abcell		G7 p.404:70mm
a. a_____	airway
b. b_____	blood pressure
c. c_____	CPR
d. e_____	EKG, EEG, electrolytes
e. l_____	IV
f. l_____	lumbar puncture
39. Complete the following regarding lumbar puncture (LP) after a seizure:		G7 p.404:105mm
a. LP after a seizure may show_____.	elevated white count
b. This may be b_____ p_____ p_____.	benign postictal pleocytosis
c. Treat as_____.	infection with antibiotics until cultures return
40. Medications for patients in status epilepticus and their amount are Hint: bAnd Dlpt		G7 p.404:115mm
a. b_____	bicarbonate—2 ampules IV
b. A_____	Ativan—4 mg slowly IV
c. n_____	naloxone—0.4 mg IV
d. d_____	dextrose—25 to 50 mL of a 50% solution
e. D_____	Dilantin—20 mg/kg slowly IV normal saline (NS)
f. l_____	IV NS
g. p_____	phenobarbital—20 mg/kg IV
h. t_____	thiamine—50 to 100 mg IV
41. True or False. The following medications are used in treating status epilepticus:		G7 p.405:35mm
a. lorazepam	true
b. phenytoin	true
c. phenobarbital	true
d. general anesthesia	true
e. all of the above	true
42. What is the safe rate?		G7 p.405:35mm
a. For Dilantin _____ mg/minute	50 mg/minute
b. For phenobarbital _____ mg/minute	100mg/minute
43. What IV fluid must be used for giving Dilantin and why?	normal saline to avoid precipitation	G7 p.406:18mm
44. Complete the following about diazepam:		G7 p.406:135mm
a. name (proprietary)	Valium
b. stops seizures in_____	80% in 5 minutes
c. preferred drug	no (stored in fat)
d. seizures recur in_____	in 20 minutes
e. aborts seizures %	68%
f. depresses respiration	more
g. dose	10 mg
45. Complete the following about lorazepam:		G7 p.406:145mm
a. name (proprietary)	Ativan
b. preferred drug	yes
c. aborts seizures%	97%
d. depresses respiration	less
e. dose	4mg
46. True or False. The drug of choice for myoclonic status epilepticus is		G7 p.407:40mm
a. lorazepam	true
b. benzodiazepine	false
c. Dilantin	false
d. phenobarbital	false
e. diazepam	false
47. True or False. The drug of choice for absence status epilepticus is		G7 p.407:55mm
a. valproic acid	true
b. benzodiazepine	false
c. dilantin	false
d. phenobarbital	false
e. diazepam	false

Antiepileptic Drugs

48. What % of patients can achieve control of seizures with medical therapy?	75 to 80%	G7 p.407:80mm
49. Indicate the drug of choice for each type of seizure.		G7 p.407:145mm
a. generalized tonic-clonic
i. _____ valproic acid
ii. _____ Dilantin
b. absence_____	valproic acid
c. myloclonic_____	lorazepam
d. tonic or atonic_____	lorazepam
e. partial
i. _____	Tegretol
ii. _____	Dilantin
50. True or False. Increase a given medication until seizures are controlled or side effects become intolerable, but do not rely solely on therapeutic levels, which are only a range in which most patients have seizure control without side effects.	true	G7 p.409:35mm
51. True or False. 75 to 80% of epileptics can be controlled on monotherapy.	true	G7 p.409:35mm
52. True or False. Only 10% of epileptics benefit significantly from the addition of a second drug.	True	G7 p.409:52 mm
53. True or False. If more than two AEDs are required, consider whether the patient might have nonepileptic seizures.	true	G7 p.409:52mm
54. Give the characteristics of Dilantin.		G7 p.409:155mm
a. half-life_____	24 hours, range 9 to 140 hours
b. oral loading dose_____	300 PO every 4 hours until 17 mg/kg given
c. Can we use IM route?	no
d. rate by IV_____	not more than 50 mg/min
e. permitted solution_____ _____	normal saline
f. How many half-lives until you reach a steady state?	5; therefore, 7 to 21 days
55. Complete the following about Dilantin:		G7 p.409:155mm
a. How long does it take for Dilantin to reach a steady state?	7 to 21 days
b. Dilantin can be safely withdrawn over a _____ period gradually.	4-week
c. What is the safe rate at which Dilantin may be given IV?	50 mg/minute
56. True or False. Fosphenytoin Na (Fos) injection has the following advantages over conventional IV phenytoin:		G7 p.411:40mm
a. The maximum administration rate is three times as fast (i.e., 150 mg/minute).	true
b. Fos is water soluble and therefore may be infused with saline or dextrose.	true
c. There is less venous irritation due to lower pH of 8.6 to 9 compared with 12 for Dilantin.	True
57. Study Chart. Side effects of Dilantin		G7 p.411:85mm
i. a_____	ataxia
ii. b_____	birth control pills less effective
iii. c_____	cognitive dysfunction, cerebellar degeneration
vi. d_____	drug interactions, Prozac
v. e_____	epidermal necrolysis
vi. g_____	gingival hyperplasia
vii. h_____	hirsutism
viii. l_____	liver granulomas, Lupus
ix. m_____	megaloblastic anemia
x. n_____	newborn hemorrhage
xi. o_____	osteomalacia
xii. P_____	papular rash
xiii. r_____	rickets
xiv. S_____	Stevens-Johnson syndrome/systemic lupus erythematosus (SLE)-like syndrome
–––––xv. t_____	teratogenic
–––––xvi. v_____	vitamin D antagonism
58. Describe Tegretol.		G7 p.411:135mm
a. indication
i. p_____ s_____	partial seizures
ii. t_____ n_____	trigeminal neuralgia
b. therapeutic level_____ mcg/ml	6 to 12 mcg/ml
c. side effects
i. a_____	ataxia
ii. a_____	aplastic anemia
iii. a_____	agranulocytosis
iv. b_____	blood dyscrasia
v. c_____	cymetidine
vi. d_____	drowsiness
vii. d_____	diplopia
viii. D_____	Darvon
ix. e_____	erythromycin
x. f_____	fatal hepatitis
xi. g_____	gastrointestinal upset
xii. i_____	isoniazid
xiii. S_____	Stevens-Johnson syndrome
xiv. S_____	SIADH
59. Describe carbamazepine.		G7 p.411:136 mm
a. also known as _____	Tegretol
b. test for C_____, p_____, i_____	CBC, platelets, iron
c. test according to what schedule
i. _____time(s) per week for _____ _____	1; 3 months
ii. _____time(s) per month for _____ _____	1; 3 years
d. discontinue drug if levels fall below
i. WBC _____	4,000
ii. RBC _____	3,000,000
iii. HCT _____	32
iv. platelets _____	100,000
v. reticulocytes _____	0.3%
vi. iron rises to _____	higher than 150 microgram%
e. increase dose as follows: _____ pill per _____ per _____	1 pill per day per week
60. True or False. When used for treatment of trigeminal neuralgia or partial seizures with or without generalization, carbamazepine (Tegretol) has both		G7 p.412:17mm
a. erratic oral absorption although oral suspension is absorbed more readily	true	G7 p.412:75mm
b. dramatic elevation of CBZ levels with cimetidine, isoniazid, erythromycin, and propoxyphene (Darvon) drug-drug interaction	true
61. Describe valproate.		G7 p.412:155mm
a. also known as _____	Depakote
b. indication _____	generalized tonic clonic
c. therapeutic level _____ to _____ mcg/ml	50 to 100 mcg/ml
d. side effects (list at least five)	confusion drowsy hyperammonemia hair loss liver failure neural tube defects platelet dysfunction teratogenic, tremor weight gain
62. True or False. Acetylsalicylic acid displaces valproic acid from serum protein.	true	G7 p.413:44mm
63. True or False. Valproic acid causes neural tube defects in 1 to 2% of patients.	true	G7 p.413:72mm
64. Describe phenobarbital.		G7 p.413:95mm
a. indication _____ _____ _____	generalized tonic clonic
b. therapeutic level _____mcg/ml	15to30mcg/ml
c. half-life _____, steady state _____	5 days; 30 days
d. side effects
i. c_____	cognitive
ii. d_____	drowsiness
iii. p_____ h_____	paradoxical hyperactivity
iv. h_____ in n_____	hemorrhage in newborns if mother is on phenobarbital
65. True or False. Indicate whether the following statements about antiepileptic drugs are true or false:		G7 p.413:145mm
a. Phenobarbital is a potent inducer of hepatic enzymes that metabolize other AEDs.	true
b. Cognitive impairment may be subtle and may outlast administration of the drug by at least several months.	true
c. They may cause hemorrhage in newborn if mother is on phenobarbital.	true
66. True or False. The following are characteristics of Diamox (acetazolamide):		G7 p.416:70mm
a. It reduces cerebrospinal fluid (CSF) production.	true
b. It may have antiepileptic effect either due to slight central nervous system (CNS) acidosis or due to its direct inhibition of CNS carbonic anhydrase.	true
67. Describe withdrawal of AEDs.		G7 p.418:160mm
a. taper by_____	1 unit every 2 weeks
b. role of EEG_____	if EEG shows epileptiform discharge, discourage AED withdrawal
c. relapse rate_____%	35%
d. over how long? _____ _____	8 months
68. Complete the following about antiepileptic drugs:		G7 p.419:104mm
a. What effect do antiepileptic medications have on birth control pills? They increase the _____ _____ _____.	failure rate fourfold
b. Why?
i. AEDs induce liver _____ _____ _____ _____,	microsomal cytochrome P450 enzymes
ii. which degrades the _____ _____ _____.	birth control medication
c. What is the effect of an isolated seizure on pregnancy?	little—usually cause no problem
d. The effect of status epilepticus on pregnancy is serious to _____ and _____.	mother and child
69. Considering seizures, AEDs, and birth defects, describe the following:		G7 p.419:165mm
a. effect of seizure history on incidence of fetal malformations	double 4 to 5%
b. phenobarbital and malformations	the worst 9.1%—highest rate of malformations
c. teratogenic properties in
i. Dilantin	fetal hydantoin syndrome lower IQ
ii. Tegretol	neural tube defects—rare
iii. valproate	neural tube defects 1 to 2%
d. therefore, during pregnancy
i. first choice is _____	carbamazepine—lowest dose possible (Tegretol)
ii. second choice is _____	valproic acid
iii. add _____	folate
iv. use _____	monotherapy

Seizure Surgery

70. What percent of patients are not controlled with medication?	20%	G7 p.420:85mm
71. Surgery is for refractory seizures.		G7 p.420:102mm
a. nature of seizures	severe disabling
b. length of treatment	at least 1 year
c. How many trials?	three (two mono- and one polytherapy)
72. Name the seizure types for which surgery is appropriate. Hint: teLi		G7 p.420:115mm
a. t_____	temporal
b. e_____	extratemporal
c. L_____ -G_____	Lennox-Gastaut
d. i_____ h_____ s_____	infantile hemiplegia syndrome
73. Complete the following about seizure surgery:		G7 p.420:175mm
a. Can you see a seizure on diagnostic images?	yes
b. Give examples.
i. CT with IV contrast _____ _____ _____	focus may enhance
ii. positron emission tomography (PET) _____ in _____% hypometabolism; 70%
iii. single-photon emission computed tomography (SPECT) _____ _____ _____	increased blood flow during a seizure
c. Best test for hippocampal asymmetry for MTS, which produces CPS is m_____ t_____ s_____ c_____ p_____ s_____ in_____.	mesial temporal sclerosis complex partial seizures in MRI
74. Complete the following about the Wada test:		G7 p.421:70mm
a. The purpose is to localize _____ _____.	dominant hemisphere (side of language)
b. You can be misled by
i. a_____ m_____	arteriovenous malformation (AVM)
ii. p_____ t_____ a_____	persistent trigeminal artery
iii. h_____ s_____ by p_____ c_____	hippocampus supplied by posterior circulation
75. Surgical disconnection operations available are		G7 p.422:60mm
a. c_____	callosotomy
b. h_____	hemispherectomy
c. m_____ s_____ t_____ multiple subpial transections
76. Complete the following regarding temporal lobectomy limits:		G7 p.423:100mm
a. on dominant side permitted
i. _____	4 to 5 cm
ii. too much _____	injures speech
b. on nondominant side permitted
i. _____	6 to 7 cm
ii. too much _____	contralateral partial upper quadrant homonymous hemianopsia (Hint: clpuqhh)
c. greater resection of
i. _____ will cause	8 to 9 cm
ii. _____ _____	contralateral complete upper quadrant homonymous hemianopsia (Hint: clcuqhh)
77. Complete the following about corpus callosotomy (CC):		G7 p.422:180mm
a. Indication for corpus callosotomy
i. d_____ a_____ —a_____ s_____	drop attacks—atonic seizures
ii. i_____ h_____ s_____	infantile hemiplegia syndrome
b. How much of the CC is resected?	anterior two thirds
c. Complication is _____.	akinetic mutism or reduced verbalization temporary
d. Must the anterior commissure also be sectioned?	no—less likely to get disconnection syndrome if spared
e. Contraindication	crossed dominance
f. Exclude by _____ _____ on all _____ _____.	Wada test on all left-handed persons
78. Answer the following about corpus callosotomy:		G7 p.423:58mm
a. What test should be done preoperatively?	Wada
b. In which group of patients?	left-handed
c. Why? To identify those with _____ _____.	crossed dominance
79. Answer the following about disconnection syndrome in a left-dominant person (i.e., right-handed):		G7 p.423:70mm
a. usually lasts _____	2 to 3 months
b. effect on
i. left hand _____	tactile anomia
ii. vision _____	pseudohemianopsia
iii. smell _____	anomia for smell
iv. copying figures (i.e., spatial synthesis) _____ _____ _____ _____	poor with right hand
v. speech _____	reduced spontaneity
vi. urinary _____	incontinence
vii. left-sided _____ (resembles _____)	dyspraxia (resembles hemiparesis)
c. occurs with _____	large lesions of corpus-callosum
d. less likely to occur if _____	anterior commissure is spared
80. Describe seizure surgery outcome expectations.		G7 p.424:125mm
a. incidence of being seizure free _____%	50%
b. seizures reduced by at least 50% in _____%	80%