Monitoring
After a medical treatment is initiated, patients will typically require laboratory monitoring after 1 month and then at around 3-month intervals, although this may vary depending on the specific medication used.[72][183] The results of laboratory testing must be interpreted in the context of the patient’s treatment response.
Generally, a complete blood count, electrolytes, and liver function tests are warranted. Serum drug levels are helpful in some cases, although this is most important if the medication appears to be ineffective. It is possible to monitor serum levels of all anticonvulsants, but this is most useful for the older drugs, including phenytoin, carbamazepine, valproic acid, and phenobarbital. Patients should be counseled on the most common adverse effects and idiosyncratic reactions for the particular medications that they are taking. They should be alerted to specific signs and symptoms of a severe reaction.
Patients should be encouraged to keep a record of seizures, using a diary or smartphone app. During a follow-up visit, patient seizure counts should be assessed, medication lists should be reviewed, and an assessment for adverse events (continuous, peak dose) should be made. Patients should also be monitored for mood disorders, which are common comorbidities.[57] In addition, a quality-of-life assessment is often helpful; for example, the QOLIE10.[184]
Patients on chronic anticonvulsant therapy should be monitored for possible long-term adverse effects. These may include bone loss, weight changes, behavioral changes, renal calculi, and cerebellar dysfunction.
Patients who achieve seizure freedom may eventually wish to discontinue anticonvulsant medications.
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