Lippincott chapter 12: Drugs For Epilepsy Flashcards
12.1 A 9-year-old boy is sent for neurologic evaluation
because of episodes of apparent inattention. Over the
past year, the child has experienced episodes during
which he develops a blank look on his face and his
eyes blink for 15 seconds. He immediately resumes his
previous activity. Which one the following best describes
this patient’s seizures?
A. Simple partial.
B. Complex partial.
C. Tonic–clonic.
D. Absence.
E. Myoclonic.
Correct answer = D. The patient is experiencing episodes
of absence seizures. Consciousness is impaired briefly
and they generally begin in children aged 4 to 12 years.
Diagnosis includes obtaining an EEG that shows general-
ized 3-Hz waves.
12.2 A child is experiencing absence seizures that interrupt
his ability to pay attention during school and activities.
Which of the following therapies would be most
appropriate for this patient?
A. Ethosuximide.
B. Carbamazepine.
C. Diazepam.
D. Carbamazepine plus primidone.
E. Watchful waiting.
Correct answer = A. The patient has had many seizures
that interrupt his ability to pay attention during school and
activities, so therapy is justified. Monotherapy with primary
agents is preferred for most patients. The advantages of
monotherapy include reduced frequency of adverse effects,
fewer interactions between antiepileptic drugs, lower cost,
and improved compliance. Carbamazepine and diazepam
are not indicated for absence seizures.
12.3 Which of the following drugs is most useful for the
treatment of absence seizures?
A. Topiramate.
B. Tiagabine.
C. Levetiracetam.
D. Lamotrigine.
E. Zonisamide.
Correct answer = D. Of the drugs listed, lamotrigine has
the best data for use in absence seizures and would be the
best choice. Tiagabine is only used for focal-onset seizures.
Topiramate, levetiracetam, and zonisamide may be options
if the lamotrigine does not work.
12.3 Which of the following drugs is most useful for the
treatment of absence seizures?
A. Topiramate.
B. Tiagabine.
C. Levetiracetam.
D. Lamotrigine.
E. Zonisamide.
Correct answer = D. Of the drugs listed, lamotrigine has
the best data for use in absence seizures and would be the
best choice. Tiagabine is only used for focal-onset seizures.
Topiramate, levetiracetam, and zonisamide may be options
if the lamotrigine does not work.
12.4 A 25-year-old woman with myoclonic seizures is well
controlled on valproate. She indicates that she is
interested in becoming pregnant in the next year. With
respect to her antiepilepsy medication, which of the
following should be considered?
A. Leave her on her current therapy.
B. Consider switching to lamotrigine.
C. Consider adding a second antiepilepsy medication.
D. Decrease her valproate dose.
Correct answer = B. Valproate is a poor choice in women
of child-bearing age. A review of the medication history
of this patient is warranted. If she has not tried any other
antiepilepsy medication, then consideration of another anti-
epilepsy medication may be beneficial. Studies show that
valproate taken during pregnancy can have a detrimental
effect on cognitive abilities in children.
12.5 A woman with myoclonic seizures is well controlled
with lamotrigine. She becomes pregnant and begins
to have breakthrough seizures. What is most likely
happening?
A. Her epilepsy is getting worse.
B. Lamotrigine concentrations are increasing.
C. Lamotrigine concentrations are decreasing.
D. Lamotrigine is no longer efficacious for this patient.
Correct answer = C. Pregnancy alters the pharmacokinet-
ics of lamotrigine. As pregnancy progresses, most women
require increased dosages to maintain blood concentra-
tions and seizure control.
12.6 A 42-year-old man undergoes a neurologic evaluation
because of episodes of apparent confusion. Over the
past year, the man has experienced episodes during
which he develops a blank look on his face and fails
to respond to questions. Moreover, it appears to take
several minutes before the man recovers from the
episodes. Which one of the following best describes
this type of seizure?
A. Focal (simple partial).
B. Focal (complex partial).
C. Tonic–clonic.
D. Absence.
E. Myoclonic.
Correct answer = B. The patient is experiencing episodes
of complex partial seizures. Complex partial seizures impair
consciousness and can occur in all age groups. Typically,
staring is accompanied by impaired consciousness and
recall. If asked a question, the patient might respond with an
inappropriate or unintelligible answer. Automatic movements
are associated with most complex partial seizures and
involve the mouth and face (lip-smacking, chewing, tasting,
and swallowing movements), upper extremities (fumbling,
picking, tapping, or clasping movements), vocal apparatus
(grunts or repetition of words and phrases), as are complex
acts (such as walking or mixing foods in a bowl).
12.7 A 52-year-old man has had several focal complex
partial seizures over the last year. Which one of the
following therapies would be the most appropriate
initial therapy for this patient?
A. Ethosuximide.
B. Levetiracetam.
C. Diazepam.
D. Carbamazepine plus primidone.
E. Watchful waiting.
Correct answer = B. The patient has had many seizures,
and the risks of not starting drug therapy would be substan-
tially greater than the risks of treating his seizures. Because
the patient has impaired consciousness during the seizure,
he is at risk for injury during an attack. Monotherapy with pri-
mary agents is preferred for most patients. The advantages
of monotherapy include reduced frequency of adverse
effects, absence of interactions between antiepileptic drugs,
lower cost, and improved compliance. Ethosuximide and
diazepam are not indicated for complex partial seizures.
12.8 A patient with focal complex partial seizures has been
treated for 6 months with carbamazepine but, recently,
has been experiencing breakthrough seizures on a
more frequent basis. You are considering adding a
second drug to the antiseizure regimen. Which of the
following drugs is least likely to have a pharmacokinetic
interaction with carbamazepine?
A. Topiramate.
B. Tiagabine.
C. Levetiracetam.
D. Lamotrigine.
E. Zonisamide.
Correct answer = C. Of the drugs listed, all of which are
approved as adjunct therapy for refractory focal complex
partial seizures, only levetiracetam does not affect the phar-
macokinetics of other antiepileptic drugs, and other drugs
do not significantly alter its pharmacokinetics. However,
any of the listed drugs could be added depending on the
plan and the patient characteristics. Treatment of epilepsy
is complex, and diagnosis is based on history and may
need to be reevaluated when drug therapy fails or seizures
increase
12.9 Which of the following is a first-line medication for
generalized tonic–clonic seizures?
A. Ethosuximide.
B. Felbamate.
C. Vigabatrin.
D. Ezogabine.
E. Topiramate.
Correct answer = E. Topiramate is a broad spectrum anti-
epilepsy medication that is indicated for primary generalized
tonic–clonic seizures. Ethosuximide should only be used
for absence seizures. Felbamate is reserved for refractory
seizures due to the risk of aplastic anemia and liver failure.
Vigabatrin is not indicated for generalized seizures and is
associated with visual field defects. Ezogabine is indicated for
focal seizures and has been implicated in retinal abnormalities.
12.10 A 75-year-old woman had a stroke approximately
1 month ago. She is continuing to have small focal
seizures where she fails to respond appropriately while
talking. Which of the following is the most appropriate
treatment for this individual?
A. Phenytoin.
B. Oxcarbazepine.
C. Levetiracetam.
D. Phenobarbital.
Correct answer = C. Levetiracetam is renally cleared and
prone to very few drug interactions. Elderly patients usually
have more comorbidities and are taking more medications
than younger patients. Oxcarbazepine may cause hypona-
tremia, which is more symptomatic in the elderly. Phenytoin
and phenobarbital have many drug interactions and a side
effect profile that may be especially troublesome in the
elderly age group including dizziness that may lead to falls,
cognitive issues, and bone health issues.
