Complications
Some medications are associated with severe idiosyncratic reactions, which are sometimes life-threatening. These reactions are rare occurrences, but must be made known to the patient. Early signs and symptoms are usually key to avoiding a negative outcome; immediate drug cessation and supportive care are essential. Specific reactions should be determined for each medication.
In rare cases, an anticonvulsant can worsen some seizure types. This can occur when the underlying epilepsy syndrome is unknown or incorrectly diagnosed, and an inappropriate medication is initiated.
The majority of adverse effects are noticed at the beginning of the medication titration schedule and can be limited by slowing the rate of dose increase. Many of the noticeable adverse effects will diminish with time, and the majority are completely reversible with medication cessation. In addition to short-term adverse effects, some medications, particularly the older agents, are known to have chronic deleterious effects. Specific adverse-effect concerns should be determined for each medication.
Mood disorders (e.g., depression, anxiety) are common among people with epilepsy, and can negatively impact on seizure outcome and quality of life.[177][178] Patients should be monitored for mood disorders at each review, and referred for treatment as appropriate.[54] Evidence to inform choice of antidepressant and anticonvulsant drugs in people with epilepsy and depression is very limited.[179]
Epilepsy is independently associated with a clinically meaningful increase in the risk for developing osteoporosis. Both enzyme-inducing and non-enzyme-inducing anticonvulsant drugs also increase risk of osteoporosis. Routine screening and prophylaxis should be considered in all people with epilepsy.[180]
Status epilepticus is defined as 5 or more minutes of continuous seizure activity or two or more discrete generalised tonic-clonic seizures without complete recovery between events.[173][174] It is a life-threatening condition that requires urgent treatment.
Managing airway and breathing, ensuring intravenous access, and determining electrolyte and glucose levels are important. Benzodiazepines (e.g., lorazepam, diazepam, midazolam) are effective for the termination of status epilepticus.
Evidence-based algorithms outline analytical frameworks for the evaluation and treatment of convulsive status epilepticus.[175][176]
This refers to the phenomenon of sudden, unexpected, unexplained death in people with epilepsy with no obvious cause on post-mortem examination. Incidence in adults has been reported as 1.2 per 1000 patient-years, but it may be underestimated.[181][182][183] SUDEP may be linked to poor seizure control; seizure freedom, particularly freedom from generalised tonic-clonic seizure, is strongly associated with decreased SUDEP risk.[181][184] There is some evidence that use of appropriate adjunctive therapy in patients with refractory epilepsy reduces the risk of SUDEP.[185] Interventions such as seizure detection devices, safety pillows, medications, early surgical evaluation, and educational programmes for preventing SUDEP show promise but require further study.[183][184][186]
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