Problem: Robert, 62, was involved in a car-bicycle collision three years ago where he unfortunately suffered a serious head injury despite wearing a bicycle helmet. Eyewitnesses reported that he lost consciousness upon impact, suffering from convulsions involving his arms and legs that lasted a few minutes. Robert was administered midazolam and then transported by ambulance to a local emergency department where he underwent a scan of the head that showed no skull fracture but an area of intracranial haemorrhage (a brain bleed). Robert's recovery from this traumatic brain injury (TBI) was slow but steady. He was however diagnosed with post-traumatic epilepsy after two incidences of tonic-clonic seizures. Doctors prescribed carbamazepine and valproate.
Now three years after the accident Robert's wife partner reports he is becoming forgetful and confused. With a clear association between previous TBI and the risk of dementia it is suggested that he may be suffering with vascular dementia.
Q1. Compare and contrast the medications used to control Robert's seizures that occurred directly after the accident, and in the longer term. You should include their pharmacological mechanism of action, medical use and any adverse effects that would be relevant to Robert's recovery
Q2. Discuss why this kind of dementia is being suggested as the diagnosis and the potential treatment options for Robert.