ABPN ABPN Epilepsy and Seizure Disorders 2 — Questions and Answers
Question 1: Which antiepileptic drug is considered the preferred first-line agent for juvenile myoclonic epilepsy?
- Carbamazepine
- Valproate (Correct answer)
- Phenytoin
- Gabapentin
Correct answer: Valproate
Valproate is the most effective broad-spectrum agent for JME, controlling myoclonic jerks, absence, and generalized tonic-clonic seizures.
Question 2: Which antiepileptic drug should be AVOIDED in juvenile myoclonic epilepsy because it may paradoxically worsen myoclonic seizures?
- Levetiracetam
- Lamotrigine
- Carbamazepine (Correct answer)
- Clonazepam
Correct answer: Carbamazepine
Carbamazepine is a sodium channel blocker that may worsen myoclonic and absence seizures and is contraindicated in generalized epilepsy syndromes including JME.
Question 3: A woman with epilepsy is planning a pregnancy. Which antiepileptic drug carries the highest risk of major congenital malformations and cognitive teratogenicity?
- Lamotrigine
- Levetiracetam
- Valproate (Correct answer)
- Oxcarbazepine
Correct answer: Valproate
Valproate has the highest teratogenic risk among AEDs, associated with neural tube defects, craniofacial abnormalities, and significant neurocognitive impairment in exposed offspring.
Question 4: What is the primary mechanism of action of phenytoin?
- Enhances GABA-A receptor activity
- Blocks voltage-gated sodium channels (Correct answer)
- Inhibits carbonic anhydrase
- Blocks T-type calcium channels
Correct answer: Blocks voltage-gated sodium channels
Phenytoin stabilizes neuronal membranes by blocking voltage-gated sodium channels in their inactive state, reducing repetitive high-frequency firing.
Question 5: Which antiepileptic drug is most strongly associated with Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)?
- Valproate
- Levetiracetam
- Lamotrigine (Correct answer)
- Gabapentin
Correct answer: Lamotrigine
Lamotrigine carries a significant risk of serious skin reactions including SJS/TEN, especially when titrated rapidly or combined with valproate; slow titration substantially reduces this risk.
Question 6: What is the first-line pharmacological treatment for convulsive status epilepticus in an adult presenting to the emergency department with IV access?
- Phenytoin IV
- Valproate IV
- Lorazepam IV (Correct answer)
- Phenobarbital IV
Correct answer: Lorazepam IV
Benzodiazepines—specifically lorazepam IV (0.1 mg/kg)—are the first-line treatment for status epilepticus due to their rapid onset and proven efficacy.
Question 7: Which antiepileptic drug primarily blocks T-type calcium channels and is the first-line treatment for childhood absence epilepsy?
- Phenobarbital
- Ethosuximide (Correct answer)
- Lamotrigine
- Oxcarbazepine
Correct answer: Ethosuximide
Ethosuximide selectively blocks thalamic T-type calcium channels, disrupting the thalamocortical rhythms responsible for absence seizures, and is considered first-line for absence-only epilepsy.
ABPN ABPN Epilepsy and Seizure Disorders 2
Which antiepileptic drug is considered the preferred first-line agent for juvenile myoclonic epilepsy?