Focal seizures

Patients taking anticonvulsant drugs for focal seizures should be followed up on a regular basis. The frequency of follow-up depends on several factors. Patients whose seizures are well controlled and who are not having adverse effects with medication may be seen every 6 months to 1 year. Patients having their medications adjusted or titrated should be seen every 1 to 2 months until they are stable. Intervening telephone or video follow-up may substitute for interval visits.

Patients should be encouraged to keep written seizure diaries. During a follow-up visit, patient seizure counts should be assessed, medication lists should be reviewed (and preferably the actual medication bottles), and an assessment for adverse events (continuous, peak dose) should be made. Patients should also be screened for mood disorders, which are common comorbidities. In addition, a quality-of-life assessment is often helpful: for example, the QOLIE10. PROQOLID: Quality of Life in Epilepsy Inventory-10 (QOLIE-10) Opens in new window

For patients on first-generation anticonvulsants, drug levels, full blood count, and SMA-20 (total cholesterol, total protein, and various electrolytes) are often useful. These drugs have a narrow therapeutic index, and monitoring can assess adherence as well as provide surveillance of certain haematopoietic and hepatic toxicities. Laboratory testing for patients on second- and third-generation anticonvulsants may provide information about adherence, but a role in guiding dosing is less certain.

Patients with focal seizures who require chronic anticonvulsant therapy should be closely monitored for possible long-term adverse effects. These may include bone loss, weight changes, behavioural changes, renal calculi, and cerebellar dysfunction.

Patients who achieve seizure freedom may eventually wish to discontinue anticonvulsant medications. See Management approach.