Medicine

A 32 years old Bengali women had fever since 48 hours with history of irrelevant talk and 2 episodes of tonic clonic seizures on succession on the way to hospital. She was previously alright. Which of the following drug can be given while rest of the investigations were being carried out?

Name: A 32 years old Bengali women had fever since 48 hours with history of irrelevant talk and 2 episodes of tonic clonic seizures on succession on the way to hospital. She was previously alright. Which of the following drug can be given while rest of the investigations were being carried out?
Published: 2024-04-13T16:55:12+05:30
Keywords: Medicine

💡 Explanation

**Core Concept:** Seizures are neurological events characterized by abnormal electrical activity in the brain, leading to alterations in consciousness, movement, and sensation. The given case presents a patient with fever, irrelevant talk, and seizures, suggesting a potential seizure disorder or encephalopathy.

**Why the Correct Answer is Right:** In this scenario, the correct answer is **D** Phenytoin, a broad-spectrum anti-epileptic drug (AED) used to control seizures by inhibiting voltage-gated sodium channels in neurons, reducing neuronal excitability and preventing seizures.

**Why Each Wrong Option is Incorrect:**

A. **Lorazepam (Option A)** is a benzodiazepine, which acts as a positive allosteric modulator of gamma-aminobutyric acid (GABA) receptors, enhancing the inhibitory effect of GABA and decreasing neuronal excitability. However, the patient's seizures are not controlled with lorazepam monotherapy and a more potent AED like phenytoin should be considered.

B. **Levetiracetam (Option B)** is also an AED that works by binding to synaptic vesicle protein 2A, regulating neurotransmitter release, and inhibiting neuronal excitability. However, the patient's seizures are not controlled with levetiracetam monotherapy and a more potent AED like phenytoin should be considered.

C. **Pethidine (Option C)** is an opioid analgesic with minimal effect on seizures. It is not an appropriate choice for controlling seizures in this case.

**Clinical Pearl:** In addition to controlling seizures, choose an AED based on the seizure type (e.g., partial, generalized, or multifocal) and patient factors (e.g., age, pregnancy status, renal function). Adequate seizure control often requires a combination of two or more AEDs, not just a single drug.

**Explanation:** The patient with uncontrolled seizures despite fever and irrelevant talk requires an urgent intervention. The correct choice is **D** Phenytoin, a potent anti-epileptic drug. Phenytoin is a widely used AED that works by inhibiting voltage-gated sodium channels in neurons, reducing neuronal excitability and controlling seizures.

**Why Each Wrong Option is Incorrect:**

- Lorazepam (Option A): While lorazepam is effective in controlling seizures, it is often used as an adjunct to other AEDs, not as a monotherapy.
- Levetiracetam (Option B): Levetiracetam is effective for partial seizures, but not generalized tonic-clonic seizures, as in this case.
- Pethidine (Option C): Pethidine is an opioid analgesic with minimal effect on seizures. It is not an appropriate choice for controlling seizures in this case.

✓ Correct Answer: D. IV acyclovir

A 32 years old Bengali women had fever since 48 hours with history of irrelevant talk and 2 episodes of tonic clonic seizures on succession on the way to hospital. She was previously alright. Which of the following drug can be given while rest of the investigations were being carried out?

A 32 years old Bengali women had fever since 48 hours with history of irrelevant talk and 2 episodes of tonic clonic seizures on succession on the way to hospital. She was previously alright. Which of the following drug can be given while rest of the investigations were being carried out?

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