Seizure Quiz 2 Flashcards
A 23 y/o F patient suffers from absence seizures. Which of the following statements about her drug management is NOT correct?
A) Ethosuximide and valproic acid are preferred drugs
B) The patient should be examined every 2 or 3 months for deep tendon reflex activity
C) The use of valproic acid in pregnancy may cause congenital malformations
D) Weight gain is common in patients on valproic acid
B – ethosuximide and valproic acid are preferred for absence seizures because they cause minimal sedation
Valproic acid causes GI distress and weight gain, and is potentially hepatotoxic. In addition, its use in pregnancy has been associated with teratogenicity (neural tube defects). Peripheral neuropathy, including diminished DTRs in the LE, occurs with the chronic use of PHENYTOIN, not valproic acid.
A 9 y/o child is having learning difficulties at school. He has brief lapses of awareness with eyelid fluttering that occurs every 5-10 minutes. EEG studies reveal brief 3-Hz spike and wave discharges appearing synchronously in all leads. Which drug would be effective in this child without the disadvantages of excessive sedation or tolerance development?
A) Clonazepam
B) Diazepam
C) Ethosuximide
D) Gabapentin
C – this child is suffering from absence seizures, and 2 of the drugs above (clonazepam and ethosuximide) are effective in this disorder. Clonazepam is effective but exerts troublesome CNS-depressant effects, and tolerance can develop with chronic use.
Ethosuximide is not excessively sedating, and tolerance does not develop to its antiseizure activity. Valproic acid is also used in absence seizures.
Abrupt withdrawal of antiseizure drugs can result in increases in seizure frequency and severity. Withdrawal is most easily accomplished if the patient is treated with:
A) Carbamazepine
B) Clonazepam
C) Ethosuximide
D) Phenobarbital
C – as a rule, withdrawal from drugs used for absence seizures (valproic acid, ethosuximide) is easier than withdrawal from drugs used for partial and tonic-clonic seizures. Withdrawal is most difficult in patients who have been treated with barbiturates and benzodiazpines
A 16 y/o M patient suffers from a seizure disorder characterized by tonic rigidity of the extremities followed in 15-30s of tremor progressing to massive jerking of the body. This clonic phase lasts for 1 or 2 min, leaving him in a stuporous state. Of the following drugs, which is most suitable for long term management of this patient?
A) Clonazepam
B) Ethosuximide
C) Phenytoin
D) Pregabalin
C – this patient is suffering from generalized tonic-clonic seizures. For many years, the drug of choice in this disorder has been carbamazepine, phenytoin, or valproic acid. Many newer drugs are also effective, including gabapentin, lamotrigine, levetiracetem, topiramate, and zonisamide.
Clonazepam and ethosuximide are not effective for tonic clonic seizures. Pregabalin is only approved for use in partial seizures.
