Established seizure disorder on antiepileptic therapy; assess control, adverse effects, lifestyle.
History taking
- • Seizure frequency, type, triggers
- • Medication adherence, side effects
- • Driving, occupation, contraception, pregnancy plans
Examination
- • General: vitals, pallor, icterus, oedema, lymphadenopathy
- • Focused system examination
- • Look for red-flag findings
Red flags
- • Haemodynamic instability
- • Rapid deterioration
- • Severe pain or new neurological deficit
Differential diagnosis
- • See differentials section per chief complaint
Recommended investigations
- • AED levels (phenytoin, carbamazepine) if non-adherence / toxicity
- • LFT, CBC on enzyme inducers
Diagnosis
- • Clinical diagnosis supported by targeted investigations
Initial treatment / management
- • Treat underlying cause
- • Symptomatic relief
- • Patient education
Follow-up advice
- • Review in 2–4 weeks or earlier if worsening
- • Monitor response to therapy and adverse effects
Patient counselling
- • Driving rules (seizure-free period varies by jurisdiction)
- • Pregnancy: avoid valproate in females of childbearing age
- • Folate 5 mg/day pre-conception
Referral criteria
- • Refer if diagnostic uncertainty, complications, or failure of first-line therapy
Clinical pearls
- • Switching brands can cause breakthrough seizures — prescribe by brand if patient stable
References
- • Harrison's Principles of Internal Medicine, 21e
- • NICE / WHO guidelines (current edition)
Educational outpatient guide — verify against local guidelines before clinical use.
