Q: Which of the following anti-seizure drug should be given with caution with intravenous infusion of propofol particularly in the treatment of status epilepticus? 

A) Topiramate 
B) Carbamazepine
C) Fosphenytoin
D) Gabapentin
E) Lacosamide


Answer: A 

Topiramate is a broad spectrum antiseizure medicine, and is available only in oral form. There is no intravenous version available. It has shown to show beneficial effect in refractory status epilepticus when given in a higher dose (up to 1600 mg/day), via nasogastric tube (NGT). But, caution should be exercised when given together with intravenous propofol as Topiramate itself can cause a metabolic acidosis, and may become a synergistic medium for propofol infusion syndrome.


References:

1. Towne AR, Garnett LK, Waterhouse EJ, et al. The use of topiramate in refractory status epilepticus. Neurology 2003; 60:332.

2. Reuber M, Evans J, Bamford JM. Topiramate in drug-resistant complex partial status epilepticus. Eur J Neurol 2002; 9:111.