Epilepsy is a common brain condition with moderate prevalence of 40 to 70 people per 100,000 individuals in the population per year (Thijs et al., 2019). Risk factors for epilepsy are unique to age group with developmental issues causing most cases of childhood epilepsy while head trauma, genetics, and infections contributing to cases in adulthood. Remission rates are high in developed countries, mainly due to the use of antiseizure drugs (Thijs et al., 2019). Early diagnosis id, however necessary for proper management of the conditions as well as avoidance of injuries related to seizure attack. This paper presents a management plan for the patient through the assessment of personal and medical history, therapy, and follow up care targeting long-term remission.
Patient’s Personal and Medical History
The examined patient first began feeling lightheaded with frequent headaches three months ago, after long hours of work. She is a 28-year-old female who came to the hospital, accompanied by her sister. She had a seizure attack the morning before the hospital visit. Her sister reported that before the attack, she stared blankly without communicating before letting out screams as she lost control of her senses. The episode lasted for about 15 minutes before she woke up feeling confused and fatigued. She lived alone, and her schedule involved six days of work and free time spent with friends. She was visiting her sister at the time of the attack. She, however, reported that her work involved long hours of standing with minimal breaks in between. She occasionally takes fatigue medication and sleeping pills to help her complete tough weeks at work. She intimated that she would sometimes take more than the recommended dosage to feel the effects of the drugs. Further probing revealed no close family member had suffered seizures, but a few of the extended family were affected at some point. Her medical history shows no major health issues except for a short stint of illness during her childhood.
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An electroencephalogram (EEG) provided the diagnosis, although the frequency was unlikely to be predicted, considering that the patient had only experienced a single attack. An assessment of the patient's personal and medical history points to genetic causes as the most probable explanation for the seizure. Genetic causes of epilepsy are complex, although current knowledge ties genes responsible for direction movement of ion channels to the abnormal brain activities that result in seizures (Thijs et al., 2019). There are; however multiple genes involves, making it challenging to perform genetic testing.
Drug Therapy and Treatment
Drug therapy for the patient will consider the age, affected brain areas, and side effects of the drug. Considering the genetic cause of the patient’s epilepsy, it is likely that it affects the whole brain. The most common medication for the kind of epilepsy is valproic acid and lamotrigine (Tang et al., 2017). While the two drugs can effectively work together, monotherapy is preferable in this case to ensure proper patient adherence, avoid drug interaction, and eliminate effects of high toxicity (Thijs et al., 2019). Studies have indicated that valproic acid has the capability to affect hormonal balance in women in childbearing age and negatively affect fetal development (Gotlib et al., 2017). The age of the patient thus puts her at risk of these undesirable effects hence the decision to administer lamotrigine, which is much safer. The patient will thus be started on lamotrigine to prevent seizures while monitoring the reaction and possible future occurrences. The patient will be started on a low dosage while monitoring a response to the medication.
The success rate of antiseizure medication in causing long-term remission of seizure is seven in ten patients (Thijs et al., 2019). The considerably high success rate means that the patient has a high chance of attaining full recovery, especially due to the early diagnosis. Lamotrigine has relatively mild side effects in most people, and informing the patient ensures proper adherence. Common side effects include dizziness and nausea, slight headache, and rashes. Some individuals may also experience tremors, stomach upset, and a sore throat. Importantly, follow up for the patient is necessary both in the short-term and long-term to ensure a proper response to the provided medication. The patient will take the prescribed medication and come for a follow-up appointment after two weeks. She should, however, stay with an adult and desist from activities such as driving, operating heavy machinery, or engaging in physically demanding sports within the time. She should also get adequate rest with just a few hours of work. She should also stay on the lookout for symptoms that she experienced before her first seizure and call the clinic once she notices the signs.
Age Impact on Selected Care
Young children and adults above the age of fifty are at higher risk of getting epileptic seizures than other population groups (Oto, 2017). The patient thus falls outside the high-risk group, although there was a need for age-specific group care for the care. Maintaining hormonal balance for a crucial consideration given the age of the patient. As such, the selected drug is likely to course the little hormonal disturbance, although effects may be different for various individuals. Its negative effects informed the rejection of valproate of the development of the fetus hence the use of lamotrigine. While the patient did not report being pregnant, the longterm use of the drug necessitated the selection of a drug that did not affect the balance of hormones.
References
Gotlib, D., Ramaswamy, R., Kurlander, J. E., DeRiggi, A., & Riba, M. (2017). Valproic acid in women and girls of childbearing age. CurrentPpsychiatry Reports , 19 (9), 58.
Oto, M. M. (2017). The misdiagnosis of epilepsy: appraising risks and managing uncertainty. Seizure , 44 , 143-146. https://doi.org/10.1016/j.seizure.2016.11.029
Tang, L., Ge, L., Wu, W., Yang, X., Rui, P., Wu, Y. ... & Wang, X. (2017). Lamotrigine versus valproic acid monotherapy for generalised epilepsy: A meta-analysis of comparative studies. Seizure , 51 , 95-101. https://doi.org/10.1016/j.seizure.2017.08.001
Thijs, R. D., Surges, R., O'Brien, T. J., & Sander, J. W. (2019). Epilepsy in adults. The Lancet . 393 (10172), 689-701. https://doi.org/10.1016/S0140-6736(18)32596-0
