Patient discussions

Provide all patients with accurate information, including:[189]

  • The risk of future seizure events

  • The diagnostic tests that will be required to confirm an epilepsy diagnosis

  • Anticonvulsant medications and other treatments

  • Education about sudden unexpected death in epilepsy (SUDEP)

  • Other potential complications or comorbidities (e.g., mood disorders).

Provide patients with clear written instructions about medications and dosing. Patients often need to be reminded that they should take their medications at the same times every day. Advise patients to check with their epilepsy doctor before starting over-the-counter, alternative, or prescribed medications, as some may interact with their anticonvulsant medication and lead to either breakthrough seizures or toxicity.

When medication is started or changed, inform the patient of the adverse effects, rare idiosyncratic reactions, and warning signs, and the plans for routine monitoring or laboratory studies, for the particular drug(s) they are taking. If a generic bioequivalent anticonvulsant drug replaces a brand product, the patient should be reassured about equivalent effectiveness, and informed if there are any changes in colour or shape.[190]

Perhaps the most important discussion with the patient should focus on safety precautions. Advise patients about sleep hygiene, to avoid working night shifts, and to avoid alcohol because it increases seizure potential. Counsel patients about working at heights or near machinery, hot surfaces, or open flames, and being near or in large bodies of water, especially when alone.

The issue of driving restriction must be addressed; for an unprovoked seizure, the patient must cease driving immediately. Mandatory reporting to government licensing agencies and restriction periods vary by location; specific regulations should be researched by the treating physician. Resumption of driving depends on the legal standards of each specific locality. In general, the range of required seizure-freedom is 3 to 12 months, but specific rules should be checked for each locale.

Family members should be instructed in the proper means of attending to a person having a seizure.

If discontinuation of anticonvulsant medication is being considered for patients who have been seizure-free for at least 2 years, discuss the risks and benefits of discontinuation with the patient, including the risks of seizure recurrence and treatment resistance. Individual patient characteristics and preferences, including quality of life considerations, should be considered.[159] 

Women of childbearing potential and pregnancy

Education about effective contraceptive options and potential adverse pregnancy outcomes should continue throughout a patient's reproductive life, because anticonvulsant medication, contraceptive needs, and desire for pregnancy are likely to change over time.[83]​​

Inform women of childbearing potential that they must follow a pregnancy prevention programme while on treatment with valproic acid and its derivatives.​ Some countries may also require that a pregnancy prevention programme is in place for other anticonvulsants (e.g., topiramate).

Inform women that:

  • Being seizure-free for at least 9 months before pregnancy is probably associated with a high rate of remaining seizure-free during pregnancy

  • If they smoke they may have a substantially increased risk of premature contractions and premature labour and birth.[80]

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