Monitoring
Every child with epilepsy should be seen by a specialist at least once per year, but frequency may be as often as every 3 months depending on the child's circumstances.[27] Each child should have a comprehensive individualised care plan that is agreed on by the patient (if old enough), the family, the primary care practitioner, and the specialist.
When epilepsy is well controlled, the only necessary monitoring is for continued control of seizures and adverse effects of medication. Special attention should be paid to sedative adverse effects, which are especially difficult to determine in infants and mentally impaired children.[45]
Regular screening of cognition, behaviour, and mood is recommended for children with epilepsy.[127][176]
Serum drug level monitoring is not routinely recommended, but may be useful in cases of drug-resistant seizures, when toxic effects are suspected, when pharmacokinetic interactions may have an influence on efficacy, or when comorbidities may alter the drug's metabolism.[27] Baseline measurement and regular monitoring of various parameters (i.e., LFTs, FBC) may be helpful in monitoring for adverse effects associated with some anticonvulsants (e.g., valproate, carbamazepine) and for patients taking enzyme-inducing anticonvulsants.
Abnormal electroencephalogram (EEG) can be a predictor of relapse, although some authors report prolonged remissions despite remaining paroxysmal activity. Therefore, EEG has a secondary role in regulating medical treatment, and there are no strict regulations on how often it should be obtained.
Patients who achieve seizure freedom may eventually wish to discontinue anticonvulsant medications. See 'Drug discontinuation' in Management approach.
Use of this content is subject to our disclaimer