Seizure Disorders in Adults

Epilepsy and seizures have been described and treatment has been attempted for at least 4000 years. There are early accounts describing treatment of seizures in ancient Persia, India, and China. Treatments have ranged from drinking a gladiator’s blood in first century Rome to the modern era of antiepileptic drugs (AEDs). Potassium bromide was first introduced as treatment for epilepsy in 1857. Phenobarbital and phenytoin followed in the first part of the 20th century. Scientific advances have expanded the AED armamentarium to about 20 drugs that are currently available. Pharmacist involvement in epilepsy treatment and monitoring exploded in the 1960s with the advent of clinical pharmacy. Therapeutic drug monitoring was recognized as an important component of AED treatment after a 1960 study on a correlation between phenytoin serum concentrations, electroencephalographic findings, and clinical status. This chapter updates pharmacists regarding the care of patients with epilepsy. A review of the pathophysiology of epilepsy is followed by a discussion of patient care. New developments in pharmacological and surgical approaches to epilepsy treatment are discussed along with a review of recently developed clinical treatment guidelines. Special emphasis is placed on treatment of women with epilepsy. Also addressed are drug monitoring, patient education, and quality improvement.