Seizure Disorders USMLE Step 1 Practice Question
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?
Answer choices
- AImmediately discontinue levetiracetam due to suicidality risk
- BInitiate fluoxetine for mood stabilization without medication changes
- CIncrease levetiracetam dose to improve seizure threshold
- DCheck serum levetiracetam levels and psychiatric evaluation; consider drug discontinuation or replacementCorrect answer
- ERefer to psychiatry only; continue all current medications unchanged
- FObtain brain MRI with contrast to rule out temporal lobe tumor causing behavioral changes
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