J Clin Outcomes Manage
Case studies in optimizing antiepileptic treatment
Pathmanathan JS, Parkerson KA, Milligan TA
Abstract Objective: T o review 3 cases drawn from the clinic that highlight difficulties in epilepsy management and illustrate an approach to treatment and its rationale. Methods: Case presentations and literature review. Results: Epilepsy is a chronic disease, and as such presents challenges to patients and physicians in a variety of settings. Patients with epilepsy face the same health risks as the general population, such as heart disease, stroke, and infection. However, treatment for these conditions must be tailored to minimize impact on seizure control as well as interactions with antiseizure medications. In addition to these risks, patients with epilepsy are at high risk of depression and other psychiatric comorbidities, which should be recognized and treated as part of a comprehensive management plan. In addition, patients with epilepsy will face the same life events as nonepileptic patients, such as pregnancy and childbirth, but with optimal management will have relatively few adverse outcomes. The challenge to physicians is to determine optimal management, which sometimes means changing, minimizing, or discontinuing antiepileptic therapy. Conclusion: Treatment decisions must take into account individual patient characteristics, patient and physician preferences, cost and tolerability of available therapies, and must be balanced between the risk of seizures and the risks of therapy.
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