Antiepileptics, not otherwise specified; 7 or more
CPT4 code
Name of the Procedure:
Antiepileptics, not otherwise specified; 7 or more Common name(s): Antiepileptic drug (AED) therapy, Seizure medication regimen, Polytherapy for epilepsy
Summary
Antiepileptic drug (AED) therapy involving seven or more medications is a treatment strategy to control seizures in patients with epilepsy who have not responded to fewer medications. This regimen is typically managed by a neurologist and tailored to individual patient needs.
Purpose
Medical condition/problem: Epilepsy with refractory (treatment-resistant) seizures Goals/expected outcomes: To achieve better seizure control, improve quality of life, and minimize seizure-related injuries.
Indications
Specific symptoms/conditions: Frequent and severe seizures that do not respond to less complex medication regimens. Patient criteria: Patients who have tried and failed to achieve adequate seizure control with fewer than seven antiepileptic medications, and those who have specific genetic or metabolic conditions requiring complex regimens.
Preparation
Pre-procedure instructions:
- Routine blood tests to check kidney and liver function.
- Review current medications with a neurologist.
- Maintain a seizure diary to document frequency and type of seizures.
Procedure Description
- Assessment: Comprehensive evaluation by a neurologist, including medical history, seizure diary review, and diagnostic tests (e.g., EEG, MRI).
- Medication plan: Creation of a tailored AED regimen involving seven or more medications. This involves:
- Selecting appropriate drugs based on seizure type and patient response.
- Calculating dosages and scheduling administration times.
- Monitoring: Regular follow-up visits to monitor drug levels, side effects, and seizure control.
- Adjustment: Fine-tuning the medication regimen as needed.
Tools, equipment, technology:
- Blood tests for drug monitoring.
- EEG for brain activity monitoring.
- Medication administration tools (e.g., pill organizers).
Anesthesia or sedation: Not applicable.
Duration
Initial assessment: Approximately 1-2 hours. Follow-up visits: Typically 30 minutes to 1 hour, as needed.
Setting
Neurologist’s office, epilepsy clinic, or hospital outpatient department.
Personnel
- Neurologist
- Pharmacist
- Nurses
- Laboratory technicians for blood tests
Risks and Complications
Common risks: Drowsiness, dizziness, gastrointestinal upset, mood changes. Rare risks: Serious allergic reactions, liver or kidney damage, drug interactions.
Benefits
Expected benefits: Improved seizure control, reduced seizure frequency, increased safety and quality of life. Realization: It may take weeks to months to achieve optimal seizure control and benefits.
Recovery
Post-procedure care: Regular monitoring of side effects and seizure control, medication adherence. Expected recovery time: Ongoing treatment; the regimen is continually adjusted. Restrictions: Avoid driving or operating heavy machinery until seizures are well-controlled. Follow-up: Regular appointments with a neurologist to monitor progress.
Alternatives
Other treatment options:
- Monotherapy or fewer AEDs.
- Surgical options (e.g., vagus nerve stimulation, resective surgery).
- Dietary therapy (e.g., ketogenic diet). Pros and cons:
- Fewer AEDs: Fewer side effects, but may not control seizures.
- Surgery: Potential for significant seizure reduction but includes surgical risks.
- Dietary therapy: Non-pharmacological but can be challenging to maintain.
Patient Experience
During the procedure: Regular blood tests and clinic visits. After the procedure: Possible side effects from multiple medications, but potential for improved seizure control. Pain management and comfort measures: Medications adjusted to minimize side effects; supportive care for managing side effects.