A 34-year-old man with temporal lobe epilepsy controlled on levetiracetam for 3 years presents with a 2-week history of mood lability, irritability, anger outbursts, and suicidal ideation. Vitals show BP 128/82, HR 88, RR 16, temperature 37°C. He denies recent seizures, medication non-compliance, or substance use. EEG shows no acute epileptiform activity. Recent comprehensive metabolic panel is normal. Which of the following is the most appropriate next step?
- A)Immediately discontinue levetiracetam due to suicidality risk
- B)Initiate fluoxetine for mood stabilization without medication changes
- C)Increase levetiracetam dose to improve seizure threshold
- D)Check serum levetiracetam levels and psychiatric evaluation; consider drug discontinuation or replacementGABARITO
- E)Refer to psychiatry only; continue all current medications unchanged
Explicação
Levetiracetam is associated with behavioral changes (irritability, mood lability, suicidality) in 5-10% of patients. Upon emergence of psychiatric symptoms, serum levels should be checked, psychiatric evaluation obtained, and serious consideration given to tap... Ver explicação completa e trilha adaptativa →