Last edited: 12/19/2022

DRUGS FOR EPILEPSY

Drugs for Epilepsy Medical Editor: Jan Camille Santico & Gerard Jude Loyola

I) REVIEW QUESTIONS WITH ANSWERS

QUESTION ANSWER

1) A 12 year old boy was rushed to the ER after his A. Focal

mother witnessed him convulse, which she
described as follows: “His left arm stiffened and This is an example of a focal seizure which progressed to a
jerked first, then both arms and legs stiffened”. generalized seizure. The symptoms started with just one
This is most likely what type of seizure? side/extremity, but eventually progressed to a bilateral
a) Focal presentation.
b) Generalized
c) Epileptic Spasm
d) Undetermined

2) A 55 year old male, a known diabetic, C. Idiopathic

hypertensive, and alcoholic, was rushed to the ER
for a severe headache and a generalized seizure Since the patient is a known diabetic, hyperglycemia is a
episode. The following are likely etiologies of his possible cause
seizure EXCEPT: Since the patient is hypertensive and presented with a severe
a) Hyperglycemia headache, intracranial hemorrhage is a possible cause
b) Intracranial Hemorrhage Since the patient is an alcoholic, drugs/toxins is a possible
c) Idiopathic cause
d) Drugs / Toxins Idiopathic causes (e.g, epilepsy) is the least likely cause

3) Which of the following statements is FALSE? B. When GABA binds to its receptor, an influx of
a) Glutamate is an excitatory neurotransmitter sodium ions leads to the inhibition of action
b) When GABA binds to its receptor, an influx of potential
sodium ions leads to the inhibition of action
When GABA binds to its receptor, chloride ions enter the cell,
potential
NOT sodium ions.
c) In glutaminergic neurons, calcium ions bind to
vesicles to facilitate their fusion with the cell
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d) Increased GABA uptake leads to inhibition of
action potential in the post-synaptic neuron

4) A 9-year-old boy is sent for neurologic evaluation C. Absence

because of episodes of apparent inattention. Over
Classic in younger individuals with blank stares
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 best
describes seizures in this patient?
a) Focal
b) Tonic-clonic
c) Absence
d) Myoclonic

5) A child is experiencing absence seizures that A. Ethosuximide

interrupt his ability to pay attention during school
and activities. Which therapy is most appropriate Remember in absence seizures, you can use valproate,
for this patient? lamotrigine or ethosuximide. In children, ethosuximide is
a) Ethosuximide preferred.
b) Carbamazepine
c) Diazepam
d) Watchful waiting

6) Which drug is most useful for the treatment of D. Lamotrigine

absence seizures?
a) Topiramate
b) Tiagabine
c) Levetiracetam
d) Lamotrigine

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7) A 25-year-old woman with generalized seizures is B. Consider switching to Lamotrigine
well controlled on valproate. She indicates that she
is interested in becoming pregnant in the next Valproate, carbamazepine, and phenytoin have teratogenic
year. With respect to her antiseizure medication, effects.
which of the following should be considered?
a) Leave her on her current therapy
b) Consider switching to Lamotrigine
c) Consider adding a 2nd antiseizure medication
d) Decrease her valproate dose

8) A patient with focal seizures has been treated for 6 C. Levetiracetam

months with carbamazepine but, recently, has
been experiencing breakthrough seizures on a Levetiracetam has less or no CYP450 interactions.
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

9) A 75-year-old woman had a stroke approximately 1 C. Levetiracetam

month ago. She is continuing to have small focal
seizures where she fails to respond appropriately For focal seizures, consider phenytoin, oxcarbazepine, and
while talking. Which is the most appropriate levetiracetam.
treatment for this individual?
a) Phenytoin Phenobarbital is not a good option. Only effective for neonates
b) Oxcarbazepine or status epilepticus.
c) Levetiracetam
d) Phenobarbital Phenytoin is not a great as compared to oxcarbazepine and
levetiracetam. Levetiracetam is a better option considering
the age because of little ADRs.

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