Medical Emergencies · patient case with 2 questions
Autistic patient taking an antiepileptic
Patient: Patient with autism spectrum disorder
Chief complaint: Attends for routine dental care.
Background: Epilepsy, treated with valproic acid. History of generalised tonic–clonic seizures.
Current findings: Cooperative with a structured, predictable approach.
Question 1
Which is NOT a feature of a generalised tonic–clonic seizure?
Show answer and explanation
Correct answer: B. Repetitive verbal behaviour
- A. Loss of consciousness is definitional for a generalised seizure.
- B. CORRECT — this is the EXCEPTION. Repetitive verbal or motor behaviour (stereotypy) is a feature of AUTISM, and repetitive automatisms such as lip-smacking characterise FOCAL seizures with impaired awareness. It is not a feature of a generalised tonic–clonic seizure, in which consciousness is lost outright.
- C. Tonic rigidity followed by clonic jerking is the defining motor sequence.
- D. The patient is entirely unresponsive throughout.
Question 2
Which oral side effect is associated with long-term valproic acid therapy?
Show answer and explanation
Correct answer: A. Increased bleeding tendency from thrombocytopenia and platelet dysfunction
- A. CORRECT. Valproate causes dose-dependent THROMBOCYTOPENIA and impairs platelet function, so bleeding after surgical procedures is the relevant concern. A platelet count and coagulation screen are worth obtaining before surgery. Valproate is also hepatotoxic, which matters for drug selection.
- B. Gingival overgrowth is classically associated with PHENYTOIN, and also with ciclosporin and calcium channel blockers such as nifedipine — not valproate.
- C. Intrinsic staining is associated with tetracycline exposure during development.
- D. Valproate does not characteristically cause xerostomia.
Note: Distinguish carefully: PHENYTOIN causes gingival overgrowth; VALPROATE causes bleeding tendency.