What is the first-line treatment for epilepsy?

A 25-year-old male patient with a history of generalized tonic-clonic seizures presents to the clinic for a follow-up appointment. His seizure frequency has increased despite being on phenytoin for the past 6 months. He also complains of dizziness, unsteady gait, and double vision. Neurological examination revealed ataxia and nystagmus. CT scan of the brain is normal. What should be the next step in the management of this patient’s epilepsy.

What should be the next step in the management of this patient’s epilepsy?

A 2-year-old female with history of epilepsy and mitochondrial myopathy is brought to the ED after experiencing 10 seizures at home. Upon ED arrival, patient continues seizing despite receiving midazolam 5 mg IM in route. She weighs 13 kg and peripheral IV access was quickly established.  Which of the following urgent control therapies would be LEAST appropriate for this patient?

FH is a 32-year-old female with new onset epilepsy presenting to the ED for feeling off since starting phenytoin outpatient. Her vital signs upon presentation are blood pressure 132/88 mmHg, heart rate 80 bpm, respiratory rate 14 breaths/min, and O2 saturation of 99% on room air with a point-of-care blood glucose of 114 mg/dL.. She worries that phenytoin is contributing to her symptoms and inquires about its side effects. Which of the following is not a side effect of phenytoin?

L.M. is a 32-year-old female with a history of focal seizures. She has been on carbamazepine for 3 years and her current carbamazepine concentration is 11 mcg/mL. Her past medical history includes hypothyroidism and glaucoma. She has a family history of epilepsy in her mother and brother. L.M. reports experiencing intermittent blurred vision and double vision over the past few months. Based on L.M.’s patient profile and current carbamazepine concentration, which adverse effect is she most likely experiencing?