Case 032: Epilepsy

PATIENT PRESENTATION

Chief Complaint

“I had a seizure”

History of Present Illness

A 68-year-old woman is seen in clinic after being treated 4 days ago in the emergency department for a seizure.

Link to EMR

Student Work-Up

TARGETED QUESTIONS

1. What diagnostic tests should be done before starting pharmacotherapy for seizures?

   Hint: See Treatment in PPP

2. When selecting a seizure medication, what factors need to be considered?

   Hint: See Treatment in PPP

3. What seizure type does this patient likely have?

   Hint: See Table 32-1 and Outcome Evaluation in PPP

4. What seizure medication would be the best to start in this patient?

   Hint: See Table 32-2 in PPP

5. How should this patient be monitored for seizures and the new medication?

   Hint: See Table 32-4 in PPP

FOLLOW-UP

This patient has several other medications, what important drug interactions to consider?

Hint: See Table 32-5 in PPP

CASE SUMMARY

Global Perspective

New onset seizures are common in older adults. This patient population presents some unique challenges due to concurrent diseases and multiple medications. To appropriately manage these patients, an accurate diagnosis and careful selection of a seizure medication is essential. Additionally, these patients must be carefully monitored for adverse effects and dose adjustments of seizure medications due to other medications and physiologic changes in organ function (e.g., kidney function)

Key References