Antiseizure medicines: selection, adverse effects and monitoring — formative SAQs

SAQ 1 (10)

A ten-year-old boy with newly diagnosed focal epilepsy is started on levetiracetam. Two weeks later his parents report that he has become increasingly irritable and aggressive, with two episodes of hitting a classmate, which is unlike his baseline. His seizures are controlled. ^{[5] [1]}

a) Name the adverse effect, estimate its approximate frequency in children on this drug, and explain why this drug has a favourable interaction profile despite this behavioural effect. (3 marks) ^[5]

b) Outline three management options for this adverse effect, and state the principle that governs the choice between them. (3 marks) ^[5]

c) The family asks whether carbamazepine, used by an uncle with epilepsy, might be a better choice. State the spectrum classification of carbamazepine and explain why it is or is not appropriate for this child. (2 marks) ^[1]

d) Describe the baseline and follow-up monitoring you would arrange for a child on this drug, and explain why routine therapeutic drug monitoring is not required. (2 marks) ^[5]