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Pediatric Epilepsy Syndromes 07

Topic: Pediatric

Created on Thursday, October 4 2007 by jdmiles

Last modified on Thursday, October 4 2007.

A 16 year old girl presents after having a generalized tonic-clonic seizure. She has noticed that, when she brushes her teeth or combs her hair in the morning, she occasionally experiences a brief, involuntary jerk in her upper extremities. Past medical history is otherwise unremarkable. There is no family history of seizures. Exam is normal. You obtain an EEG, which reveals occasional generalized bilateral polyspikes and spike wave complexes at 5Hz.

Of the following options, which agent is the best choice as a first-line monotherapy treatment?

A) Valproate

B) Tiagabine

C) Felbamate

D) Phenytoin

E) Oxcarbazepine

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This question was created on October 04, 2007 by jdmiles.
This question was last modified on October 04, 2007.

ANSWERS AND EXPLANATIONS

A) Valproate

This answer is correct.

This child has juvenile myoclonic epilepsy. Valproate is considered the initial treatment of choice. Lamotrigine and topiramate, while not approved by the FDA for this use, are also commonly used as initial monotherapy. (See References)


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B) Tiagabine

This answer is incorrect.

This child has juvenile myoclonic epilepsy. Tiagabine is not the preferred first-line agent in the treatment of this syndrome.

(See References)


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C) Felbamate

This answer is incorrect.

This child has juvenile myoclonic epilepsy. Felbamate has an increased risk for potentially fatal hepatotoxicity, and is therefore not the initial treatment of choice. (See References)


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D) Phenytoin

This answer is incorrect.

This child has juvenile myoclonic epilepsy. Phenytoin is not the preferred first-line agent in the treatment of this syndrome. Phenytoin may worsen myoclonus if used as monotherapy.

(See References)


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E) Oxcarbazepine

This answer is incorrect.

This child has juvenile myoclonic epilepsy. Oxcarbazepine is not the preferred first-line agent in the treatment of this syndrome. Oxcarbazepine may worsen myoclonic seizures.

(See References)


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References:

1. Levin, K.H., and Luders, H.O. (Eds.) (2000). Comprehensive Clinical Neurophysiology. W.B. Saunders Company, Philadelphia.
2. Trescher, W.H., and Lesser, R.P. (2004). The epilepsies. In Bradley, W.G., Daroff, R.B., Fenichel, G.M., and Jankovic, J. (Eds.). Neurology in Clinical Practice, Fourth Edition. Butterworth Heinemann, Philadelphia, pp. 1953-1992.
3. Wheless, J.W., Clarke, D.F., and Carpenter, D. (2005). "Treatment of pediatric epilepsy: expert opinion, 2005." J Child Neurol, 20 Suppl 1 S1-56; quiz S59-60. (PMID:16615562)
4. Murphy, ., and Delanty, . (2000). "Primary Generalized Epilepsies." Curr Treat Options Neurol, 2(6) 527-542. (PMID:11096777)
5. Gelisse, P., Genton, P., Kuate, C., Pesenti, A., Baldy-Moulinier, M., and Crespel, A. (2004). "Worsening of seizures by oxcarbazepine in juvenile idiopathic generalized epilepsies." Epilepsia, 45(10) 1282-6. (PMID:15461683)
6. Prasad, A., Kuzniecky, R.I., Knowlton, R.C., Welty, T.E., Martin, R.C., Mendez, M., and Faught, R.E. (2003). "Evolving antiepileptic drug treatment in juvenile myoclonic epilepsy." Arch Neurol, 60(8) 1100-5. (PMID:12925366)


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pediatric
Pediatric Epilepsy Syndromes 07
Question ID: 100407125
Question written by J. Douglas Miles, (C) 2006-2009, all rights reserved.
Created: 10/04/2007
Modified: 10/04/2007
Estimated Permutations: 30240