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MEDICAL TREATMENT OF SEIZURES: TERMS YOU NEED TO KNOW – DRUG LEVELS AND TOXICITY

admin — Wed, 18 May 2011 13:10:49 +0000

Drug levels. The term “drug level” refers to the amount of a medication in the blood—to be more precise, the serum levels, since the drug is in the liquid portion of your blood (serum) rather than in the red blood cells. To be still more precise, we should refer to the amount of “free” drug in the serum, since virtually all of a drug is tightly bound to the proteins in the serum and cannot get into the brain to exert its effect; only the tiny “free” (unbound) portion can enter the brain to affect the seizures. When we measure “drug levels” or “blood levels,” we usually measure the total amount of a drug in the serum. In most cases this is sufficient, but we can, when necessary, measure the free portion as well, although it is a somewhat more expensive test. In general, when we talk about drug levels in this chapter, we are referring to serum levels.
Toxicity. The term “toxicity” covers a multitude of things. Toxicity, in general, is used here to refer to the adverse (bad) effects of a medication. There are two major forms of such toxicity: allergic and dose-related. The allergic form may be mild (such as a rash) or severe, affecting the blood cells, bone marrow, or liver, reactions that can be serious and, rarely, even fatal. The dose-related form depends on the amount of medication in the brain. Toxicity may be observed as sleepiness (sedation), unsteadiness (ataxia), tremor, or even as problems in learning. Dose-related toxicities are important to recognize, and when recognized are seldom serious, because they are reversible by a decreasing or a discontinuing of the drug.
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SEIZURES AND EPILEPSY IN CHILDHOOD: UNDERSTANDING YOUR CHILD’S TESTS – VIDEO-EEG MONITORING IN EPILEPSY CENTERS

admin — Wed, 16 Feb 2011 16:13:42 +0000

A small, but growing, number of epilepsy centers are now capable of intensive video-EEG monitoring. Video-EEG monitoring is usually carried out in special hospital settings with the patient in bed or sitting in a chair where the video camera and EEG machine can constantly monitor his activities. The EEG and the video are recorded simultaneously in one of several ways which will permit simultaneous analysis of the behavior and the electrical activity. Often these intensive monitoring centers will withdraw medication to precipitate seizures, which can then be recorded.
The principal drawback to this monitoring is its present expense. It requires the use of hospital space and the time of nurses or technicians who will monitor the patient and the equipment twenty-four hours a day. Also, analysis of the records is expensive and time consuming. Because seizures must be of sufficient frequency to make their recording feasible, intensive video-EEG monitoring may require many days in the special monitoring unit at enormous cost. Also, there is far more demand for available monitoring than there is space available, and waiting lists often extend for many months.
However, when seizures are sufficiently frequent and disabling to the individual, or when the localization of the onset of seizures is sufficiently important to future decision-making about the use of the proper medication or the use of surgery, then intensive monitoring, expensive as it is, is cost-effective and worth waiting for. The goals of hospital admission and monitoring must, of course, be carefully defined in advance in order to make the most efficient use of this complex system.
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LIVING WITH EPILEPSY: SENSIBLE RESTRICTIONS ON ACTIVITIES AND EPILEPSY AS A SOCIAL WEAPON

admin — Tue, 28 Apr 2009 12:38:38 +0000

Many relatives of people with epilepsy are naturally concerned as to what may happen during a seizure if they are not present to assist. We have known this anxiety carried to extremes. One of our patients, an epileptic woman of 30, was still sharing her parents’ bedroom, as they were concerned that she might come to harm during a nocturnal seizure, even though she had had none for 15 years! In practice, harm resulting from seizures is exceptionally rare, but there are a few sensible precautions.

Epilepsy as a social weapon-Families must be aware of ways in which epilepsy can be ‘used’. The child or young person with epilepsy, knowing of his parents’ anxiety about him, may manipulate them into granting him unreasonable requests. They may give in to feeling sorry for his difficulties, or they may feel that they should avoid an emotional upset that might precipitate a seizure. There is no reason why a child with epilepsy should not experience the same discipline as his siblings, who will themselves become jealous and unruly if they feel that one member of the family is being spoiled.

The other side of the coin is that parents may use the threat of epilepsy as a means of controlling behaviour which they otherwise cannot control. Examples we have met include limiting the hours of television watched, and the lateness of the hour by which an adolescent with epilepsy must return home.

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