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EEGs in persons
with DD often show only diffuse background slowing and may not yield
therapeutically useful information when no clinical events are
occurring. It is important to seek
input from an epileptologist if seizure control is suboptimal or there are
concerns regarding side effects of the medication regimen. A clinical pharmacist may provide useful
input regarding ways to minimize side effects while optimizing therapeutic
efficacy and recommendations on timing and interval for drug level
checks. Most anticonvulsants will
have some side important effects. Of
particular concern in the DD population are the effects on sensorium. It is important that the general principle
of maintaining the fewest number of drugs in order to minimize adverse
effects be applied. If a single
anti-epileptic has been titrated to the highest clinically acceptable level
without obtaining the desired therapeutic response, a second drug should be
added and, when seizure control is obtained, the first drug withdrawn. Some
individuals whose seizures have been refractory to drug treatment may benefit
from surgical intervention.
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Withdrawal of
anticonvulsants after extended seizure-free periods (typically greater than
two years) can be attempted. The
success rate in this population is lower than in those without DD. Withdrawal should be done slowly. Seizures may occur during withdrawal and
may either be withdrawal seizures, which will ultimately cease, or seizures
that require reintroduction of antiepileptics to control. Therefore discontinuation of
antiepileptics should be attempted with caution and safety measures in place.
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Management of
epilepsy treatment should be based on objective data including seizure
frequency, duration, intensity, and type as well as drug levels and side
effects. Patients and their
caretakers can be provided tracking forms to collect this data and bring it
to appointments. The risks of drug
treatment should be weighed against the adverse effects of seizures. Are the seizures generalized and prolonged
or do they consist of a few muscle jerks once or twice a day? Does the medication suppress the bone
marrow and irritate the stomach or is it relatively side-effect free? Link to guideline on seizure
medications goes here.
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