11-01-2009, 10:38 AM
A 25-year-old man comes to your clinic stating that he can no longer take his seizure medication because his gums "look horrible." He is seeing you for the first time. He has been on phenytoin 100 mg, three times a day, for the last 6 years for generalized tonic-clonic seizures. Despite therapeutic levels of phenytoin, he also experiences occasional jerking of his extremities and has spells in which he "blanks out" for a few seconds. His physical examination shows gingival hyperplasia. His neurological exam is within normal limits. An MRI of his head was normal two years ago. Also, an EEG performed one year ago showed generalized spike and wave abnormalities. What is the most appropriate recommendation at this time?
(A) Start gabapentin and taper the phenytoin
(B) Discontinue phenytoin and switch to carbamazepine
© Increase the dose of phenytoin from 300 to 400 mg daily
(D) Serum phenytoin level and liver function tests should be obtained and the dosage adjusted
(E) Add valproic acid and taper the phenytoin
(F) Continue the phenytoin and tell him not to operate a moving vehicle for at least one year
(A) Start gabapentin and taper the phenytoin
(B) Discontinue phenytoin and switch to carbamazepine
© Increase the dose of phenytoin from 300 to 400 mg daily
(D) Serum phenytoin level and liver function tests should be obtained and the dosage adjusted
(E) Add valproic acid and taper the phenytoin
(F) Continue the phenytoin and tell him not to operate a moving vehicle for at least one year