Absence seizures

In the event of a generalised tonic-clonic seizure, the patient should be positioned on their side on a firm, flat surface. Nothing should be placed in the patient's mouth. If any seizure persists for longer than 5 minutes, either an abortive agent (such as rectal diazepam) should be administered or emergency personnel contacted.

Patients with a history of seizures should not swim alone or take baths. Heights and cooking over an open flame should be avoided.

Restrictions regarding driving are mandated by state law and vary from state to state. In general, patients are not allowed to drive unless they have been seizure free for at least 6 months.

Patients should be in regular contact with their prescribing physician if they continue to have seizures.

If a generic bioequivalent anticonvulsant drug replaces a brand product, patients (and parents/carers if appropriate) should be reassured about equivalent effectiveness, and informed if there are any changes in colour or shape.[89]American Epilepsy Society. Position statements: substitution of different formulations of antiseizure medication for the treatment of epilepsy. Aug 2023 [internet publication]. https://www.aesnet.org/about/about-aes/position-statements/substitution-of-different-formulations-of-antiepileptic-drugs-for-the-treatment-of-epilepsy

If discontinuation of anticonvulsant medication is being considered for patients who have been seizure-free for 2 years or more, discuss the risks and benefits of discontinuation with the patient (and their family if appropriate), including the risks of seizure recurrence and treatment resistance. Individual patient characteristics and preferences, including quality of life considerations, should be taken into account.[68]Gloss D, Pargeon K, Pack A, et al. Antiseizure medication withdrawal in seizure-free patients: practice advisory update summary: report of the AAN guideline subcommittee. Neurology. 2021 Dec 7;97(23):1072-81. https://www.doi.org/10.1212/WNL.0000000000012944 http://www.ncbi.nlm.nih.gov/pubmed/34873018?tool=bestpractice.com

Females of childbearing potential should be informed that they must follow a pregnancy prevention programme while on treatment with valproate medicines. For EU countries, the European Medicines Agency state that this programme should include:[66]European Medicines Agency. New measures to avoid valproate exposure in pregnancy endorsed. EMA/145600/2018. March 2018 [internet publication]. http://www.ema.europa.eu/docs/en_GB/document_library/Referrals_document/Valproate_2017_31/Position_provided_by_CMDh/WC500246350.pdf

• An assessment of the patient’s potential for becoming pregnant

• Pregnancy tests before starting and during treatment as needed

• Counselling about the risks of valproate treatment and the need for effective contraception throughout treatment

• A review of ongoing treatment by a specialist at least annually

• A risk acknowledgement form that patients and prescribers will go through at each such annual review to confirm that appropriate advice has been given and understood.