Barbara Jaime
Florida National University
Advanced Pharmacology-DAX-DL01
Dra. Yesenia Osle
January 18, 2023
Risk Factors, Diagnosis, and Treatment for Epilepsy
Epilepsy is s common health disorder that affects the brain and may result in seizures. Brain abnormalities such as brain tumors, stroke, and vascular malformation are the major cause of epilepsy (Anwar et al., 2020). The problem can start at any age but is common among children and the elderly. Stroke is the leading cause of epilepsy among adults. Based on LS’s medical history, some of the major risk factors initiated the occurrence of epilepsy in the long-term use of Fluoxetine, 40 mg once daily. In this case, Fluoxetine carries a greater risk of seizure. The Second risk factor is febrile convulsion during her childhood.
Electroencephalogram is the common diagnostic method for epilepsy. However, in LS’s case, she indicates normal electrolytes. Thus, diagnostic studies may involve Magnetic resonance imaging (MRI). The method uses powerful radio waves and magnetic to establish a detailed view of the brain and detect abnormalities causing seizures (Bernasconi et al., 2019). Therefore, the physician may acquire the right information about the brain and establish proper treatment or management of the condition. After EEG is obtained, indicating the existence of epilepsy, the next course of action includes testing for the efficacy and tolerability of medication for the patient (Santamarina et al., 2020). In this case, patient testing for efficacy will ensure that the therapeutic process involving medication is compatible with the patient’s immune response. LS will then be under appropriate medication to enhance positive outcomes fro
JUSTIN COWAN
9 minutes ago, at 5:43 AM
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Advanced Pharmacology Discussion Week 3: Justin Cowan
Based upon the clinical presentation of LS, the provider can safely determine that the patient is beginning to develop epilepsy. Epilepsy is known as a chronic disease of the brain in which the patient suffers from a persistent predisposition to have seizure activity of the brain (Beghi, 2020). This condition is unprovoked by any obvious central nervous system insult such as in the case of our patient LS in which she begins to experience an aura and a subsequent seizure. Epilepsy affects both sexes and all age groups, however there is an increased frequency of epilepsy within the elderly related to their higher incidence of strokes, neurodegenerative diseases, and tumors (Beghi, 2020). Changes in levels of various electrolytes are known be another cause of seizure activity, this is particularly noted in hyponatremia and hypercalcemia. (Secore, 2021). Hyperglycemia and hypoglycemia have also been attributed to isolated seizure episodes (Secore, 2021). There exist two broad types of seizures which include focal or localization, and generalized seizures (Secore, 2021). Focal seizures, like the neuroactivity noted in LS’s EEG begin within one cerebral hemisphere and localized abnormalities are demonstrated on the EEG (Secore, 2021). Focal seizures are also able to spread into the brainstem and both hemispheres of the brain causing alterations in consciousness such as with LS’s original seizure episode (Secore, 2021). Once the seizure spreads bilaterally and involves the motor cortex, the patient now begins to suffer from a secondary generalized tonic-clonic seizure, also known as bilateral convulsive seizures (Secore, 2021). LS is suffering from this form of seizure that originates from her focal seizures.
Important risk factors that may have contributed to LS’s seizure activity include her usage of duloxetine and previous history of childhood febrile seizures. It is important to ask LS if she has abruptly discontinued her Duloxetine therapy. Duloxetine is known to have several severe symptoms from withdrawal such as confusion, hypomania, and seizures (Gold Standard, 2023). There exist several risk factors that can assist in the development of epilepsy such as perinatal complications, developmental delay, family history of epilepsy, previous intracranial surgery, and most importantly in LS’s case, childhood febrile convulsions. (Luu et al., 2021). Further diagnostic studies to better determine LS’s risk for future unprovoked seizures and the potential causes include magnetic resonance imaging and computer tomography to check for structural abnormalities, tumors, trauma, or cerebrovascular accident (Secore, 2021). An EEG is indicated for further diagnostics as well and was performed.
LS should be started on anticonvulsant medication therapy post epilepsy diagnosis. According to Luu et al. (2021), nearly half of patients become seizure-free post medication therapy of a well-tolerated first anticonvulsant. Drug therapy is targeted toward the seizure type experienced and comorbidities (Luu et al., 2021). As a first-line therapy recommendation for LS levetiracetam, carbamazepine, oxcarbazepine, zonisamide, gabapentin, or lamotrigine are all options as LS’s EEG indicates that her seizures are localized to the right temporal lobe (Luu et al., 2021). This indicates that she is experiencing a focal seizure prior to any generalizations or evolutions of the seizure episodes that are occurring.
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