FrontalCortex, Inc. is a non-profit corporation dedicated to neurology education.

The Tricky Pills!

Topic: Adult

Created on Saturday, December 20 2008 by rednucleus

Last modified on Saturday, December 20 2008.

A 32-year-old woman visits the neurologist's office because of developing many seizures. She was diagnosed with primary generalized tonic-clonic fits, 10 years ago for which she takes lamotrigine tablets, 200 mg a day. She says that her fits were well-controlled, and she develops an average 2 fits per year, until 3 months ago when her fits seemed to increase in frequency of around 3 fits a week. She denies doing drugs and she takes daily tonics and oral conventional contraceptive pills for the past 4 months. She neither smokes nor drinks alcohol and there is no history of head trauma. She insists that she is compliant with her anti-epileptic and she is desperate for your help. Her neurological examination is unremarkable. What is the cause of the recent worsening?

 
        A) Contraceptive pills
 
        B) Occult brain tumor
 
        C) Cortical scar
 
        D) Lamotrigine non-compliance
 
        E) Surreptitious drug abuse
 

 


Back to the question = Go back to the top of the page.
See another question like this one = Reload a different version of this question ().
Click here for a random question = Load a random question from the database.
Clone this question = Use this question as a template to create a totally NEW question.
Rate this question = Enter detailed rating for this question!
Average rating not yet available
= How users like you have rated this question.
This question was created on December 20, 2008 by rednucleus.
This question was last modified on December 20, 2008.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ANSWERS AND EXPLANATIONS




A) Contraceptive pills

This answer is correct.


A common theme in examinations is to see contraception failure because of using anti-epileptics (like phenytoin, primidone…etc). What is unusual to neurology trainees is to encounter anti-epileptics failure because of using contraceptive pills! Lamotrigine is an excellent choice for epileptic women taking oral contraceptives or those planning pregnancy, as it neither affects the metabolism of the pills nor has a teratogenic effect. However, conventional oral contraceptive pills have been shown to "decrease" serum levels and efficacy of lamotrigine by about 100%; therefore, these breakthrough seizures in this can be assumed to be to the introduction of oral contraceptives (4 months ago). To correct this fault, increase the daily dose of lamotrigine by 50-100% (gradually) and watch for the optimal dose. Nothing in the scenario points towards a possible brain tumor or cortical scar (like previous head injury). Although surreptitious drug abuse is a possibility, the pills option is more reasonable to consider.  (See References)

Back to the questionSee another question like this oneClick here for a random questionClone this question Rate this question
Average rating not yet available
Please log in if you want to rate questions.

 

 

 

 

 

 

 

 

 




B) Occult brain tumor

This answer is incorrect.


A common theme in examinations is to see contraception failure because of using anti-epileptics (like phenytoin, primidone…etc). What is unusual to neurology trainees is to encounter anti-epileptics failure because of using contraceptive pills! Lamotrigine is an excellent choice for epileptic women taking oral contraceptives or those planning pregnancy, as it neither affects the metabolism of the pills nor has a teratogenic effect. However, conventional oral contraceptive pills have been shown to "decrease" serum levels and efficacy of lamotrigine by about 100%; therefore, these breakthrough seizures in this can be assumed to be to the introduction of oral contraceptives (4 months ago). To correct this fault, increase the daily dose of lamotrigine by 50-100% (gradually) and watch for the optimal dose. Nothing in the scenario points towards a possible brain tumor or cortical scar (like previous head injury). Although surreptitious drug abuse is a possibility, the pills option is more reasonable to consider.  (See References)

Back to the questionSee another question like this oneClick here for a random questionClone this question Rate this question
Average rating not yet available
Please log in if you want to rate questions.

 

 

 

 

 

 

 

 

 




C) Cortical scar

This answer is incorrect.


A common theme in examinations is to see contraception failure because of using anti-epileptics (like phenytoin, primidone…etc). What is unusual to neurology trainees is to encounter anti-epileptics failure because of using contraceptive pills! Lamotrigine is an excellent choice for epileptic women taking oral contraceptives or those planning pregnancy, as it neither affects the metabolism of the pills nor has a teratogenic effect. However, conventional oral contraceptive pills have been shown to "decrease" serum levels and efficacy of lamotrigine by about 100%; therefore, these breakthrough seizures in this can be assumed to be to the introduction of oral contraceptives (4 months ago). To correct this fault, increase the daily dose of lamotrigine by 50-100% (gradually) and watch for the optimal dose. Nothing in the scenario points towards a possible brain tumor or cortical scar (like previous head injury). Although surreptitious drug abuse is a possibility, the pills option is more reasonable to consider.  (See References)

Back to the questionSee another question like this oneClick here for a random questionClone this question Rate this question
Average rating not yet available
Please log in if you want to rate questions.

 

 

 

 

 

 

 

 

 




D) Lamotrigine non-compliance

This answer is incorrect.


A common theme in examinations is to see contraception failure because of using anti-epileptics (like phenytoin, primidone…etc). What is unusual to neurology trainees is to encounter anti-epileptics failure because of using contraceptive pills! Lamotrigine is an excellent choice for epileptic women taking oral contraceptives or those planning pregnancy, as it neither affects the metabolism of the pills nor has a teratogenic effect. However, conventional oral contraceptive pills have been shown to "decrease" serum levels and efficacy of lamotrigine by about 100%; therefore, these breakthrough seizures in this can be assumed to be to the introduction of oral contraceptives (4 months ago). To correct this fault, increase the daily dose of lamotrigine by 50-100% (gradually) and watch for the optimal dose. Nothing in the scenario points towards a possible brain tumor or cortical scar (like previous head injury). Although surreptitious drug abuse is a possibility, the pills option is more reasonable to consider.  (See References)

Back to the questionSee another question like this oneClick here for a random questionClone this question Rate this question
Average rating not yet available
Please log in if you want to rate questions.

 

 

 

 

 

 

 

 

 




E) Surreptitious drug abuse

This answer is incorrect.


A common theme in examinations is to see contraception failure because of using anti-epileptics (like phenytoin, primidone…etc). What is unusual to neurology trainees is to encounter anti-epileptics failure because of using contraceptive pills! Lamotrigine is an excellent choice for epileptic women taking oral contraceptives or those planning pregnancy, as it neither affects the metabolism of the pills nor has a teratogenic effect. However, conventional oral contraceptive pills have been shown to "decrease" serum levels and efficacy of lamotrigine by about 100%; therefore, these breakthrough seizures in this can be assumed to be to the introduction of oral contraceptives (4 months ago). To correct this fault, increase the daily dose of lamotrigine by 50-100% (gradually) and watch for the optimal dose. Nothing in the scenario points towards a possible brain tumor or cortical scar (like previous head injury). Although surreptitious drug abuse is a possibility, the pills option is more reasonable to consider.  (See References)

Back to the questionSee another question like this oneClick here for a random questionClone this question Rate this question
Average rating not yet available
Please log in if you want to rate questions.

 

 

 

 

References:

1. Victor, M., and Ropper, A.H. (2005). Adams and Victor's Principles of Neurology, 8th Edition. McGraw-Hill, New York. (ISBN:007141620X)Advertising:
Back to the questionSee another question like this oneClick here for a random questionClone this question Rate this question
Average rating not yet available
Please log in if you want to rate questions.

 

FrontalCortex.com -- Neurology Review Questions -- Neurology Boards -- Board Review -- Residency Inservice Training Exam -- RITE Exam Review
adult
The Tricky Pills!
Question ID: 122008027
Question written by rednucleus. (C) FrontalCortex.com 2006-2009, all rights reserved. Created: 12/20/2008
Modified: 12/20/2008
Estimated Permutations: 120

User Comments About This Question:

0 user entries
Please log in if you'd like to add a comment.