ABPN Epilepsy and Seizure Disorders Flashcards

Which antiepileptic drug is considered the preferred first-line agent for juvenile myoclonic epilepsy?

Answer: Valproate

Valproate is the most effective broad-spectrum agent for JME, controlling myoclonic jerks, absence, and generalized tonic-clonic seizures.

Which antiepileptic drug should be AVOIDED in juvenile myoclonic epilepsy because it may paradoxically worsen myoclonic seizures?

Answer: Carbamazepine

Carbamazepine is a sodium channel blocker that may worsen myoclonic and absence seizures and is contraindicated in generalized epilepsy syndromes including JME.

A woman with epilepsy is planning a pregnancy. Which antiepileptic drug carries the highest risk of major congenital malformations and cognitive teratogenicity?

Answer: Valproate

Valproate has the highest teratogenic risk among AEDs, associated with neural tube defects, craniofacial abnormalities, and significant neurocognitive impairment in exposed offspring.

What is the primary mechanism of action of phenytoin?

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.

Which antiepileptic drug is most strongly associated with Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)?

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.

What is the first-line pharmacological treatment for convulsive status epilepticus in an adult presenting to the emergency department with IV access?

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.

Which antiepileptic drug primarily blocks T-type calcium channels and is the first-line treatment for childhood absence epilepsy?

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.