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  #1  
Old 10-15-2012
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Question Developed Seizures after Folate Treatment!

Q) a 40 yr old male known epileptic and on medication from 10 yrs developed pale conjunctiva and extreme fatigue and diagnosed as megaloblastic anemia and started on folate medication....1 month after the initiation of therapy, pt. admitted for seizures, on examination his fatigue and paleness resolved with normal Hb count and detected folate excess consumption..what is the cause of seizures in this pt..?

a) due to improper interval taking of medication by pt.
b) due to folate treatment
c) due to cobalamine deficiency
d) not related with the anemia and treatment initiated
e) due to orotic aciduria

Last edited by venky2600; 10-15-2012 at 01:27 PM.
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Old 10-15-2012
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i guess D
discontinued phenytoin
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Old 10-15-2012
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B ( due to folate treatment .. Coz I think folate decreases the efficacy of phenytoin .. Remember reading it somewhere .. )
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Old 10-15-2012
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My answer is C) Due to cobalamin deficiency, because it is said in the stem of the question that patient has megaloblastic anemia that could be also caused by B12 deficiency. The anemia resolves with folate administration, but the neurological symptoms caused by vit B12 deficiency don't.
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Old 10-15-2012
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Just to clarify stuff , B 12 deficiency will not lead to seizures ..
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Old 10-15-2012
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Quote:
Originally Posted by alice View Post
Just to clarify stuff , B 12 deficiency will not lead to seizures ..
Alice, I don't understand why are you so annoyed by my answer. It was just my answer and my explication. If you don't agree with me, just say it in a nice way.
I did a little research and found some articles on pubmed, where people with seizures had in fact vitamin B 12 deficiency and had no sign of magaloblastic anemia at all. Here is the link http://www.ncbi.nlm.nih.gov/pubmed?t...ncy%20seizures.
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Teona..,really Sorry If you got offended .. It was a very casual statement .. I read somewhere in this forum earlier about there being an association of B12 with seizures .. And it turns out that it occurs in very rare instances .. But neurological defects of B 12 are are usual SACD of spinal cord .. I thought I was trying to make a point that dint go off well ..
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Old 10-15-2012
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Quote:
Originally Posted by alice View Post
Teona..,really Sorry If you got offended .. It was a very casual statement .. I read somewhere in this forum earlier about there being an association of B12 with seizures .. And it turns out that it occurs in very rare instances .. But neurological defects of B 12 are are usual SACD of spinal cord .. I thought I was trying to make a point that dint go off well ..
Ok, no problem. Maybe I misinterpreted! Let's wait for venky's explanation good luck on your studies!
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Old 10-15-2012
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Yeah .. You too !!
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Old 10-15-2012
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Thumbs Up Effect of folate on anticonvulsants drugs

Folic acid can increase how quickly the body breaks down fosphenytoin (Cerebyx). Taking folic acid along with fosphenytoin (Cerebyx) might decrease the effectiveness of fosphenytoin (Cerebyx) for preventing seizures.

Phenobarbital (Luminal) interacts with FOLIC ACID
Phenobarbital (Luminal) is used for seizures. Taking folic acid can decrease how well phenobarbital (Luminal) works for preventing seizures.




Phenytoin (Dilantin) interacts with FOLIC ACID
The body breaks down phenytoin (Dilantin) to get rid of it. Folic acid might increase how quickly the body breaks down phenytoin (Dilantin). Taking folic acid and taking phenytoin (Dilantin) might decrease the effectiveness of phenytoin (Dilantin) and increase the possibility of seizures.


Primidone (Mysoline) interacts with FOLIC ACID

Primidone (Mysoline) is used for seizures. Folic acid might cause seizure in some people. Taking folic acid can along with primidone (Mysoline) might decrease how well primidone works for preventing seizures.




Answer:B

source:http://www.webmd.com/
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Thumbs Up Effect of folate on anticonvulsants drugs

Folic acid can increase how quickly the body breaks down fosphenytoin (Cerebyx). Taking folic acid along with fosphenytoin (Cerebyx) might decrease the effectiveness of fosphenytoin (Cerebyx) for preventing seizures.

Phenobarbital (Luminal) interacts with FOLIC ACID
Phenobarbital (Luminal) is used for seizures. Taking folic acid can decrease how well phenobarbital (Luminal) works for preventing seizures.




Phenytoin (Dilantin) interacts with FOLIC ACID
The body breaks down phenytoin (Dilantin) to get rid of it. Folic acid might increase how quickly the body breaks down phenytoin (Dilantin). Taking folic acid and taking phenytoin (Dilantin) might decrease the effectiveness of phenytoin (Dilantin) and increase the possibility of seizures.


Primidone (Mysoline) interacts with FOLIC ACID

Primidone (Mysoline) is used for seizures. Folic acid might cause seizure in some people. Taking folic acid can along with primidone (Mysoline) might decrease how well primidone works for preventing seizures.




Answer:B

source:webmd
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  #12  
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Post b is the answer

the correct answer is B) folate treatment...

megaloblastic anemia is caused by 3 causes mainly-----folic acid def.,vit. B12 def. and orotic aciduria...
normally ,phenytoin causes decreased folic acid levels in blood and causes megaloblastic anemia on prolonged use........however, if excess folate doses are taken ,folate inhibit phenytoin effectiveness and decrease threshold to seizures...

here the pt. is known epileptic and on medication since 10 yrs...prolonged use causes megaloblastic anemia due to folic acid def. which pt. has presented with and due to excess dosing(excess blood folate levels), it can lead to seizures...so B is the appropriate answer

a) taking medication(phenytoin) in irregular intervals...may cause seizures but not clearly stated in stem and also excess folate levels detected

c) vit.B12 def. usually presents with neurological deficits like paresthesias,loss of proprioception likewise......seizures may also occur but rarely(although in the stem presented as already epileptic and on medication, so seizures are not new to the pt.----------it would have the right option if the pt. present with different kinda seizure[like tonic clonic in past and now with myoclonic jerks/clonic alone])

d) needless to say, the stem presented with symptoms after the treatment and also excess folate levels are detected too.......

e) orotic aciduria----folate administration may not reduce the anemia caused by it....

vit. B12 and folate deficiency anemias are always high yield and confuscious too..so aware of everything abt. them usually stem helps with giving clues like methylmalonic levels or neurological symptoms---if none given goin with stem is beneficial
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