After three incidents of mild seizures in fast succession, Patient B, a 25-year-old, was sent to a first seizure/urgent

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After three incidents of mild seizures in fast succession,
Patient B, a 25-year-old, was sent to a first seizure/urgent
evaluation neurology clinic by Accident & Emergency.
While out strolling, Patient B collapsed and passed out; a witness
contacted 911 and was able to recount what happened. Patient B is
unable to provide much information about the incident. Patient B
had no significant medical or family history, was only on the
combined oral contraceptive pill, had not drunk alcohol in the
previous 24 hours, and had a routine blood test when she went to
A&E.
A generalised tonic-clonic seizure is diagnosed by the neurologist,
who orders an MRI scan and an EEG to confirm the diagnosis.
a) Discuss why patient B was referred for both an MRI and
an EEG scan utilizing your understanding of the causes and
diagnosis of epileptic seizures.
b) Explain why one of the following anti-epileptic
pharmacological medications would be recommended as first-line
therapy. [ sodium valproate, carbamazepine, lamotrigine,
ethosuximide ]
c) Explain how the first-line anti-epileptic medication
works to manage patient B's generalised tonic-clonic seizure based
on your knowledge of drug action mechanisms.
d) At the six-month pharmacy review, patient B's seizures
are under control and she is taking her anti-epileptic medication
as recommended. Furthermore, she has been having episodes of
insomnia for the past two months and has noted that she has been
using St John's Wort, a supplementary Chinese herbal medication
suggested to her by a friend. The pharmacist explains that people
with epilepsy should avoid St John's Wort, discusses some other
choices, and sends patient B to her doctor. Discuss the logic
behind the pharmacist's suggestions and referral to the GP using
current guidelines and evidence-based management.
e) After four years of seizure-free, how may patient B's
anti-epileptic medication be discontinued?