My First Week of Adult Neurology


Attending: So! Dr Action Potential, what AED would you like to initiate?

Me: Keppra.

Attending: Correct. And why?

Me: Because… because the answer is always Keppra.

Attending: Correct.


Attending: So we all agree that the patient’s seizures are not well-controlled on Keppra. Dr Action Potential, what is at the top of your differential diagnosis?

Me: … not enough Keppra.

Attending: Interesting! So what would be your recommended course of action?

Me: … give more Keppra.

Attending: Correct.



Attending: Aha! You see, in THIS patient, we find ourselves confronting a new clinical conundrum, do we not? End-stage renal failure! Dr Action Potential, why is that a problem for our team?

Me: When the patient is in renal failure, one generally tries to avoid renally-excreted AEDs.

Attending: Correct. Clinical neurology is variable and exciting. Dr Action Potential, dare I ask, what antiepileptic would you recommend for this renal-failure patient?

Me: …the type of… Keppra… which is… renally-dosed.

Med Students: …

Attending: Correct. You know, if you didn’t tell me you spent the last 2 years in Pediatrics, I never would have guessed it. You’ve got this adult neurology thing in the bag.

Me: … Thank you, sir.

Attending: It’s quite remarkable.

Me: … I try, sir.

3 thoughts on “My First Week of Adult Neurology

  1. As entertaining as always. Bless you Dr AP, I’ve really missed your posts. Glad you haven’t lost your humour or sense of humanity.

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