A 45-year-old man with a 3-year history of poorly controlled temporal lobe epilepsy on phenytoin monotherapy presents with new-onset ataxia, tremor, and gum hyperplasia. His last seizure was 6 months ago. Serum phenytoin level is 35 mcg/mL (therapeutic range: 10-20 mcg/mL). Which of the following is the most appropriate next step?
- A)Increase phenytoin dose to maximize seizure control
- B)Add valproic acid to achieve seizure control
- C)Reduce phenytoin dose and consider alternative antiepileptic drugGABARITO
- D)Maintain current dose and add a benzodiazepine
- E)Discontinue phenytoin abruptly to prevent chronic toxicity
Explicação
The patient has supratherapeutic phenytoin levels causing chronic toxicity (ataxia, tremor) with adequate seizure control (6 months seizure-free). Dose reduction and transition to alternative therapy (e.g., levetiracetam, oxcarbazepine) is appropriate to minim... Ver explicação completa e trilha adaptativa →