๐ฉValproateisanenzyme-inhibitor, increasing the level of other medications.
Speacialy with warfarin or chemotherapy.
๐ฉThe inducers phenobarbital, phenytoin, and carbamazepine can also decrease the efectivenes so OCP.
๐ฉOral contraceptives can decrease lamotrigine levels.
I recently had a case that was initially suspected to be a tumefactive demyelinating lesion based on imaging, but it ultimately turned out to be a high-grade glioma. This highlights the importance of caution when making the diagnosis without tissue biopsy confirmation.
Maybe the best description of the general neurologist
1. Knows the 3 C's of neurology:
โข The Common
โข The Critical
โข The Curious
2. Comfortable in the ward and ICU
3. Skilled in diagnosis (localization, imaging, EDX, LP) and treatment (thrombolysis, ASMs, immunotherapy etc)