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Intraoperative ECoG — SCE Neurology MCQ

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HardClinical NeurophysiologyIntraoperative ECoGSCE Neurology

A woman stable on lamotrigine and a 21-day ethinylestradiol-containing pill develops diplopia and ataxia predictably during each pill-free week. Seizures remain controlled. Which change best addresses the pharmacokinetic fluctuation?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Consider continuous hormonal contraception without a pill-free interval, with specialist lamotrigine-level and dose review

Explanation lettering: C = shown as A · E = shown as B · D = shown as C · B = shown as D · A = shown as E

B is correct: ethinylestradiol approximately doubles lamotrigine clearance during active-pill weeks, then lamotrigine concentrations can double during the pill-free week and cause dose-related toxicity. A reverses the direction of change. C creates teratogenic, interaction and toxicity problems. D risks seizures and withdrawal. E prolongs rather than smooths the concentration surge. A continuous regimen or non-hormonal alternative needs coordinated contraceptive and epilepsy review, with levels interpreted at a consistent cycle point.

Reference: Lamotrigine 200 mg tablets SmPC: https://www.medicines.org.uk/emc/product/4740/smpc