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INTRODUCTION

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CASE LEARNING OBJECTIVES

  • Differentiate and classify seizure types when provided a description of the clinical presentation of the seizure and EEG

  • Identify key therapeutic decision points in the treatment of epilepsy

  • Establish therapeutic goals for pharmacotherapy in a patient with epilepsy

  • Recommend an appropriate pharmacotherapeutic regimen for the treatment of epilepsy

  • Select appropriate monitoring parameters for a pharmacotherapeutic regimen of epilepsy

  • Devise a plan for switching a patient from one antiepileptic regimen to a different regimen

  • Recognize complications of pharmacotherapy for epilepsy

  • Analyze potential drug interactions with antiepileptic drugs (AEDs)

  • Determine when and how to discontinue AED therapy

  • Educate a patient or caregiver on epilepsy and pharmacotherapy for this disorder

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PATIENT PRESENTATION

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Chief Complaint

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"I keep having spells where I don't remember things. My friends tell me I act weird at times, but I do not remember this."

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History of Present Illness

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James Young is a 24-year-old man who presents to his primary care physician complaining of episodes of "lost memory" for the past 3–4 months. His last routine visit was 18 months ago, and he had a normal physical examination and laboratory values at that time. He explains that these spells occur randomly and last no longer than a few minutes. From his friends, he has been told that he talks funny, smacks his lips, and his right arm jerks. When asked if he remembers these spells, he insists that he hears people talking but is unable to respond. However, he does not recall anything about what he does during these spells. Immediately after a spell he feels sleepy and somewhat confused. In addition to this description, he volunteers that he awoke a month ago feeling sore and had wet the bed.

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Past Medical History

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Multiple episodes of otitis media as a child

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Fractured arm at age 18

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Family History

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His father is 58 and has HTN and dyslipidemia. Mother is 54 and has hypothyroidism. He has two siblings in good health.

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Social History

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He was married a year ago. His wife is 5 months pregnant. He graduated from college and works at a local bank as an assistant branch manager.

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Tobacco/Alcohol/Substance Use

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Social drinker, but every few months will binge drink on a weekend; (−) tobacco or illicit drug use

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Allergies

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Sulfa (rash)

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Medications (Current)

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Multivitamin PO daily

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Loratadine 10 mg PO as needed for seasonal allergies

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Ibuprofen 200 mg PO PRN headache

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Physical Examination

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General
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WDWN, white male in no acute distress

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Vital Signs...

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