Topic: Seizure
Subject: Medicine
A patient is on carbamazepine for his new onset seizures. He has now had 3 attacks in last 2 weeks. His serum level of carbamazepine is within the therapeutic range.
What is the next step in management?
Repeat CT scan and EEG
Add another agent (eg. Phenytoin)
Re-check carbamazepine level in 2 weeks
Check CBC, CMP and TSH/FT4
Correct Answer :
B. Add another agent (eg. Phenytoin)
This patient has already been diagnosed with a seizure disorder. He has been placed on carbamazepine and is currently at a therapeutic level. But his seizures are not controlled. At this time another medication should be added. Choices include phenytoin and valproic acid.
> A repeat CT and EEG is not needed at this time.
> His carbamazepine level is therapeutic yet he still has seizures so obtaining a repeat level is not correct.
> Although lab tests may be necessary, it is not the best choice at this time.
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