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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.

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Missing Information?


Patient Database

Drug Therapy Problems

Care Plan (by Problem)


  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


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

Hint: See Table 32-5 in PPP


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

1. +
Josephson  CB, Wiebe  S, Delgado-Garcia  G.  et al. Association of Enzyme-Inducing Antiseizure Drug Use With Long-term Cardiovascular Disease. JAMA Neurol. 2021 Nov 1;78(11):1367–1374. doi: 10.1001/jamaneurol.2021.3424. Erratum in: JAMA Neurol. 2022 Jan 1;79(1):93. PMID: 34605857. 
2. +
Lezaic  N, Roussy  J, Masson  H,  et al. Epilepsy in the elderly: Unique challenges in an increasingly prevalent population. Epilepsy Behav. 2020 Jan;102:106724. doi: 10.1016/j.yebeh.2019.106724. Epub 2019 Dec 7. PMID: 31816480. 
3. +
Sen  A, Jette  N, Husain  M,  et al. Epilepsy in older people. Lancet. 2020 Feb 29;395(10225):735–748. doi: 10.1016/S0140-6736(19)33064-8. PMID: 32113502. 
4. +
Beghi  E. The Epidemiology of Epilepsy. Neuroepidemiology. 2020;54(2):185–191. doi: 10.1159/000503831. Epub 2019 Dec 18. PMID: 31852003. 
5. +
Husein  N, Josephson  CB, Keezer  MR. Understanding cardiovascular disease in older adults with epilepsy. Epilepsia. 2021 Sep;62(9):2060–2071. doi: 10.1111/epi.16991. Epub 2021 Jul 9. PMID: 34245013. 
6. +
Musaeus  CS, Nilsson  C, Cooper  C,  et al. Pharmacological Medical Treatment of Epilepsy in Patients with Dementia: A Systematic Review. Curr Alzheimer Res. 2021;18(9):689–694. doi: 10.2174/1567205018666211126121529. PMID: 34825872. 
7. +
Lee-Lane  E, Torabi  F, Lacey  A,  et al. Epilepsy, antiepileptic drugs, and ...

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