Conduct a comprehensive follow-up visit for a patient with epilepsy using appropriate history-taking techniques, physical examination, and laboratory tests. The visit includes assessment of disease control, assessment and support of adherence with lifestyle modifications and medication regimens, and evaluation for complications from the disease and medication regimen.
According to most sources, epilepsy is a condition of recurrent, unprovoked seizures caused by an inherent brain abnormality. Seizures occur when the normal chemical and electrical activity of the brain is disturbed, which leads to changes in behavior, function, or attention. These manifestations can include visible abnormal motor activity, loss of consciousness, and/or memory loss, as well as abnormal sensory, psychic, or autonomic symptoms. Focal or generalized, abnormal increased muscular activity due to a seizure is called convulsion. Because many types of epilepsy do not involve convulsions, the term is less often used in the context of epilepsy or seizure disorders.
While all drugs currently used to treat epilepsy are really antiseizure medications, which suppress abnormal electrical and chemical activity in the brain, they are usually called antiepilepsy drugs (AEDs). This is primarily because seizure activity that either consists of a single event and/or has an identifiable reversible cause does not warrant chronic drug therapy.
The pharmacist’s role in epilepsy is primarily monitoring the patient’s response to drug therapy, preventing adverse effects and assisting with optimal medication adherence.
Seizures can be triggered by numerous temporary and potentially correctable conditions such as high fever, head trauma, electrolyte disturbances, medications, alcohol withdrawal, vascular malformations, tumor, infection, or stroke. These seizures are considered to be provoked and will not recur once the offending cause is corrected. If seizures occur repeatedly and chronically, and it is not provoked by an identifiable cause, the condition is called epilepsy. Over 3 million people in the United States have epilepsy (0.5% to 1% of the population).
While the cause of a seizure disorder and the diagnosis of epilepsy is done primarily by medical personnel and physician specialists, pharmacists need to know the most common causes and how the diagnosis is made. When evaluating a patient for the first time, it is important to obtain a complete and detailed patient history. Ideally, this would include a detailed description from those who have witnessed the patient’s seizures. A complete physical examination, including a thorough neurological examination must be performed. In addition to a careful history and examination, selective laboratory screening along with other tests should be performed to look for temporary or reversible causes of the seizure. Therefore, electrolytes, glucose, calcium, magnesium, CBC, renal function, liver function, and toxicology screenings should be determined. A lumbar puncture or spinal tap is performed if the clinical presentation suggests the following: an acute infection that involves the CNS, a history of cancer that is known to ...