Outcome Evaluation

The success of treatment is measured by the early termination of seizures, without adverse drug effects or brain injury. Therefore, start pharmacologic treatment as soon as possible.

• First-line treatment for SE should halt seizure activity within minutes of administration.

• In patients who are unarousable following treatment, an EEG can confirm termination of seizures.

• Perform a physical exam and evaluation of the patient's laboratory results to help determine if the cause or complications of seizure activity are being appropriately treated.

Once seizure activity has ceased and the patient has stabilized, review the patient's therapeutic regimen.

• Evaluate and monitor serum trough concentrations of AEDs with defined target ranges to determine patient-specific therapeutic goals.

• If there is a known cause of SE, treat it and simplify therapy.

• In patients with RSE on multiple AEDs, slowly decrease the dose of one drug at a time while continuing to evaluate the patient for seizure activity.

• Base the titration schedule on the half-life of the drug and individual patient response.

• Optimize treatment using the fewest medications to prevent seizure recurrence without causing adverse drug reactions.

• Continue to monitor AED serum trough concentrations approximately every 3 to 5 days until the AEDs have reached steady-state concentrations.

• Give additional loading doses or hold doses as needed to maintain target trough concentrations.

• Monitor the patient for signs of drug toxicity and seizures until drug concentrations have stabilized.

• Drug interactions are common in patients taking multiple AEDs; therefore, closely evaluate their medication profiles and change drugs or doses to minimize any interaction, if possible.

Abbreviations Introduced in This Chapter

AEG AED CSF EEC GA13A GC5E HEENT ICP IM NCSE

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