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A Fit with Difficult Choice!

Topic: Adult

Created on Monday, October 27 2008 by rednucleus

Last modified on Monday, October 27 2008.

A 12-year-old male has been recently diagnosed with idiopathic grand mal epilepsy and his neurologist is about to prescribe an anti-epileptic for him. He is healthy-looking, with a BMI of 35 Kg/m2, normotensive, and has a normal mentation. He denies doing drugs and his family history is unremarkable. Which one of the following is the best anti-epileptic for this boy?

A) ACTH

B) Topiramate

C) Gabapentine

D) Phenobarbitone

E) Valproic acid

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This question was created on October 27, 2008 by rednucleus.
This question was last modified on October 27, 2008.

ANSWERS AND EXPLANATIONS

A) ACTH

This answer is incorrect.

ACTH is used for infantile spasms! (See References)


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B) Topiramate

This answer is correct.

Topiramate has been shown to produce weight loss; note his obesity! Although valproic acid is an excellent 1st line agent for primary generalized epilepsy, its "weight gain" side effect would preclude its use here. (See References)


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C) Gabapentine

This answer is incorrect.

Can be used for partial seizures with/without secondary generalization. Again, it can cause weight gain. (See References)


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D) Phenobarbitone

This answer is incorrect.

Although is effective against partial and generalized epilepsy, it should not be the first line agent because of its side effect profile (like cognitive impairment and sedation in children) and the presence of safer alternatives. (See References)


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E) Valproic acid

This answer is incorrect.

Can produce weight gain; note his BMI! (See References)


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References:

1. Victor, M., and Ropper, A.H. (2001). Adams and Victor's Principles of Neurology, 7th Edition. McGraw-Hill, New York. (ISBN:0070674973)

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adult
A Fit with Difficult Choice!
Question ID: 102708117
Question written by rednucleus. (C) FrontalCortex.com 2006-2009, all rights reserved. Created: 10/27/2008
Modified: 10/27/2008
Estimated Permutations: 120