Seizure Disorders USMLE Step 1 Practice Question
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?
Answer choices
- AAdd lacosamide as adjunctive antiepileptic therapy
- BIncrease levetiracetam dose to 1500 mg daily
- CRefer for comprehensive epilepsy evaluation and consideration of temporal lobe resectionCorrect answer
- DSwitch levetiracetam to phenytoin monotherapy
- EObtain 18-FDG PET imaging to identify potential seizure focus
- FPerform lumbar puncture to exclude autoimmune encephalitis
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