Epilepsy Questions

Amy Pappas, DO
5/25/18
QUESTION 1: Which drug(s) should be avoided in
idiopathic generalized and myoclonic seizures?

A. Phenytoin
B. Carbamazepine
C. Oxcarbazepine
D. Gabapentin
E. All of the above
ANSWER

A. Phenytoin
B. Carbamazepine
C. Oxcarbazepine
D. Gabapentin
E. All of the above
• Any drug that blocks sodium channels can worsen myoclonic
seizures and generalized epilepsy; including rufinamide,
gabapentin and pregabalin
QUESTION 2: Which drug has the
highest risk of suicidality?

A. Carbamazepine
B. Phenobarbitol
C. Levitiracetam
D. Valproic Acid
E. Topamax
ANSWER

A. Carbamazepine
B. Phenobarbitol
C. Levitiracetam
D. Valproic Acid
E. Topamax
• Compared to carbamazepine (4%) Phenobarbitol rate of
suicidality was 47%
QUESTION 3: Which is NOT a sign of
Phenytoin toxicity?

A. Incoordination
B. Headache
C. Nystagmus
D. Diplopia
E. Paradoxical increase in seizure
ANSWER

A. Incoordination
B. Headache
C. Nystagmus
D. Diplopia
E. Paradoxical increase in seizure
• Dilantin affects the Purkinje cells of the cerebellum, leading
to coordination issues and brainstem signs as above
QUESTION 4: Pregnancy increases
clearance of which AED?

A. Lamotrigine
B. Topiramate
C. Phenytoin
D. Carbamazepine
E. Oxcarbazepine
ANSWER

A. Lamotrigine
B. Topiramate
C. Phenytoin
D. Carbamazepine
E. Oxcarbazepine
• Monitor levels carefully in pregnancy due to hormonal shifts;
estrogen and pregnancy increase clearance and dose must
be adjusted
QUESTION 5: Which drug(s)
decrease efficacy of OCP at high
doses?
A. Carbamazepine
B. Topiramate
C. Lamotrigine
D. A and B
E. All of the above
ANSWER

A. Carbamazepine
B. Topiramate
C. Lamotrigine
D. A and B
E. All of the above
• Both are inducers of CYP3A-4 metabolism; which lowers
available estrogen concentrations

• Eslicarbazepine, rufinamide, felbamate and oxcarbazepine

also do this as well

• MUST COUNSEL women of childbearing age!

QUESTION 6: Which two drugs have class I evidence
proving efficacy in generalized absence seizures?

A. Valproic Acid and Phenytoin

B. Phenytoin and Zarontin
C. Zarontin and Valproic Acid
D. Zarontin and Carbamazepine
E. None of the above
ANSWER

A. Valproic Acid and Phenytoin

B. Phenytoin and Zarontin
C. Zarontin and Valproic Acid
D. Zarontin and Carbamazepine
E. None of the above
• Suggested efficacy noted in Lamotrigine, Clobazam,
Leviteracetam, and Zonegran but not yet proven
QUESTION 7: Which statement is
false?
A. Oxcarbazepine is more likely to cause hyponatremia
B. Carbamazepine induces its own metabolism
C. Oxcarbazepine induces its own metabolism
D. Carbamazepine can cause weight gain, decreased bone density
and hyponatremia with long-term use
E. Both bind to sodium channels
ANSWER
A. Oxcarbazepine is more likely to cause hyponatremia
B. Carbamazepine induces its own metabolism
C. Oxcarbazepine induces its own metabolism
D. Carbamazepine can cause weight gain, decreased bone density
and hyponatremia with long-term use
E. Both bind to sodium channels
• Unlike carbamazepine, oxcarbazepine is not an autoinducer
QUESTION 8: Which drug IS NOT
effective for Lennox-Gaustaut
Syndrome?
A. Clobazam
B. Felbamate
C. Lamotrigine
D. Rufinamide
E. Levetiracetam
ANSWER

A. Clobazam
B. Felbamate
C. Lamotrigine
D. Rufinamide
E. Levetiracetam
• These drugs, in addition to Topiramate have class I efficacy in
Lennox Gastaut syndrome. Valproic Acid has been suggested
to be efficacious, although not proven in clinical trials.
QUESTION 9: Gabapentin has FDA approval for
treatment of which of the following conditions?

A. Restless leg syndrome

B. Anxiety
C. Post-herpetic neuralgia
D. Tremor
E. A and C
ANSWER

A. Restless leg syndrome

B. Anxiety
C. Post-herpetic neuralgia
D. Tremor
E. A and C
• Although not FDA approved, Gabapentin is used off label for
many other conditions including other types of neuralgia,
fibromyalgia, headache, pain, sleep issues, tremor
QUESTION 10: What is the most
concerning side effect of Vigabatrin?

A. Progressive and permanent bilateral concentric visual field

constriction
B. Loss of vision in one eye
C. Aplastic anemia
D. Hyponatremia
E. Dizziness
ANSWER

A. Progressive and permanent bilateral concentric visual field

constriction
B. Loss of vision in one eye
C. Aplastic anemia
D. Hyponatremia
E. Dizziness
• This side effect is common, seen in 30-40% of individuals
• This side effect essentially limits prescribing of this
medication
QUESTION 11: What is the only drug combination that
has shown to be synergistic in human studies?

A. Valproic acid and Phenytoin

B. Phenobarbitol and Valproic Acid
C. Valproic acid and Lamotrigine
D. Lamotrigine and Levetiracetam
E. Lamotrigine and Topiramate
ANSWER

A. Valproic acid and Phenytoin

B. Phenobarbitol and Valproic Acid
C. Valproic acid and Lamotrigine
D. Lamotrigine and Levetiracetam
E. Lamotrigine and Topiramate
• Other combinations have been proven to be efficacious in
animal models; these combinations were not listed in this
article
QUESTION 12: Which drug has a
high level of protein binding?

A. Topiramate
B. Lamotrigine
C. Rufinamide
D. Perampanel
E. Carbamazepine
ANSWER

A. Topiramate
B. Lamotrigine
C. Rufinamide
D. Perampanel
E. Carbamazepine
• Perampanel is 95% protein bound and is extensively
metabolized in the liver
QUESTION 13: What is the only AED that has class
I evidence for efficacy in myoclonic seizures?

A. Levetiracetam
B. Lamotrigine
C. Felbamate
D. Valproic acid
E. Gabapentin
ANSWER

A. Levetiracetam
B. Lamotrigine
C. Felbamate
D. Valproic acid
E. Gabapentin
QUESTION 14: What percent of oral
primidone is converted to
phenobarbital?
A. 15%
B. 25%
C. 40%
D. 65%
E. 100%
ANSWER

A. 15%
B. 25%
C. 40%
D. 65%
E. 100%
• Primidone is converted in the liver to phenobarbital and
PEMA (phenylethylmalonamide), both of which are active
metabolites
QUESTION 15: Which is false about
Zonisamide?
A. Cognitive slowing is present but less compared to Topamax
B. It has weak carbonic anhydrase activity
C. It is indicated as initial monotherapy for focal seizures in the
United States
D. It is a broad spectrum AED
E. Kidney stones occur in 4% of patients
ANSWER
A. Cognitive slowing is present but less compared to Topamax
B. It has weak carbonic anhydrase activity
C. It is indicated as initial monotherapy for focal seizures in the
United States
D. It is a broad spectrum AED
E. Kidney stones occur in 4% of patients
• It is indicated as initial monotherapy for focal seizures in
Europe in Japan, but not the United States