Patient Care and Monitoring

1. Monitor the patient's seizure frequency and characteristics. The only objective measure of efficacy for AEDs is a count of seizure frequency. Ask patients to keep seizure calendars, noting the numbers and types of seizures that occur, and have them bring the calendars to clinic at every visit for analysis and documentation of seizure frequency.

2. Monitor for acute and chronic adverse effects of AED. Acute adverse effects are best detected by a thorough neurologic examination at clinic visits. Instruct patients to report sedation, ataxia, rash, or other problems immediately. Monitor for chronic adverse effects, including a loss of bone mineral density, which should be measured every 2 years in patients taking phenytoin, phenobarbital, car-bamazepine, and valproate.

3. Monitor for comorbid disease states at each clinic visit. Evaluate for depression at every clinic visit. Monitor comorbid disease states when a change in AED therapy is made.

4. Take measures to ensure compliance with medications and access to care. Compliance with medication regimens is a common problem for patients with epilepsy. Ask patients at every visit how they are taking their medications and whether they miss any doses. Identify barriers to care, such as financial issues or transportation problems.

5. Instruct patients, family members, and caregivers on first aidfor seizures. First aid for seizures consists primarily of keeping patients from hurting themselves. They should be placed on the floor, if possible, and their head cushioned. First respon-ders to a seizure should never attempt to restrain the patient or force an item into their mouth. If a seizure lasts longer than 5 to 10 minutes, emergency medical assistance should be called.

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