American Board of Internal Medicine (ABIM) Certification Practice Exam

When is inpatient epilepsy monitoring recommended for patients?

1. After a single seizure event

2. If they have not responded to one AED

3. After two or more AEDs have failed

4. When they exhibit symptoms of PNES

The correct answer is: After two or more AEDs have failed

Inpatient epilepsy monitoring is primarily indicated when a patient has not achieved seizure control despite trials of at least two antiepileptic drugs (AEDs). This recommendation is based on the need to clarify the diagnosis of seizure type, determine the frequency and nature of the seizures, and assess suitable treatment options. The failure of two different AEDs is often indicative of treatment-resistant epilepsy, which necessitates more comprehensive evaluation through monitoring, particularly to identify potential surgical candidates or to guide further therapeutic decisions. In this context, the efficacy of the management approach rests on accurately characterizing the seizure disorder, which may be difficult to assess through outpatient evaluations alone. Monitoring in a controlled inpatient setting allows for the continuous observation of seizures, video-EEG correlation, and associated clinical features, which can reveal information critical to refining the diagnosis and subsequent management plans. As for the other options, a single seizure event does not typically warrant extensive monitoring unless there are additional risk factors present; usually, it would be managed with outpatient follow-up and potentially the initiation of AED therapy. Similarly, if a patient has only failed one AED, they may still respond to other agents, making inpatient monitoring unnecessary at that stage. Even in cases of psychogenic non-epileptic seizures (PNES