A 45-year-old man with a 10-year history of left temporal lobe epilepsy presents to clinic after experiencing 3 breakthrough seizures over the past month despite reported adherence to levetiracetam 1000 mg daily. He states he has been seizure-free for the past 2 years. Vital signs are stable: BP 128/82, HR 92, RR 16, temperature 37.0°C. Neurological examination is non-focal. Serum levetiracetam level is therapeutic at 18 mcg/mL. Brain MRI obtained 3 years ago demonstrated left mesial temporal sclerosis without structural change on recent imaging. There is no history of recent head trauma, fever, or medication non-compliance. Which of the following is the most appropriate next step in management?
- A)Add lacosamide as adjunctive antiepileptic therapy
- B)Increase levetiracetam dose to 1500 mg daily
- C)Refer for comprehensive epilepsy evaluation and consideration of temporal lobe resectionGABARITO
- D)Switch levetiracetam to phenytoin monotherapy
- E)Obtain 18-FDG PET imaging to identify potential seizure focus
Explicação
This patient has drug-resistant epilepsy (DRE), defined as failure to achieve sustained seizure control despite trials of two or more appropriately chosen antiepileptic drugs (AEDs) at adequate doses. He has a documented structural lesion (mesial temporal scle... Ver explicação completa e trilha adaptativa →