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A: When an epilepsy patient experiences a sustained period of freedom from seizures (seizure control), reform suddenly experiences a seizure, such an event is commonly referred to as a breakthrough seizure. When reform breakthrough seizures occur, there can be severe reform consequences for the reform. For example, patients may need to be reform in a hospital or evaluated in the emergency room.

Sometimes fractures or head reform may occur, which could reform hospitalization. This is very important as status epilepticus is associated with elevated morbidity and, potentially, mortality. Breakthrough seizures have their own unique set of reform etiologies that should be carefully considered by the clinician, as I will discuss later.

There are a number of potential causes of the unexpected occurrence of a breakthrough seizure. One important factor that clinicians reform forget to examine is the possibility of non-adherence to (non-compliance with) prescribed antiepileptic drugs (AEDs). While adherence to medication is important in all disorders, reform is especially important in epilepsy as non-adherence can lead to the emergence of breakthrough seizures and all of the associated complications.

When assessing the causes of reform breakthrough seizure, the clinician must first establish whether the patient in question has been adherent reform the prescribed AEDs. Both reform and medication factors can contribute to the occurrence of a breakthrough seizure. Patient factors include the onset of an infection, severe emotional stress, sleep deprivation, or metabolic events such as a decrease in sodium levels or reform changes in blood sugar level.

Provocative factors such reform flashing lights or playing video games have also been known to induce a seizure. A drop in serum AED level reform provoke a seizure, and there are diverse potential causes for a reduced level.

For example, the introduction of an agent that induces hepatic metabolism can lower the level of some AEDs metabolized in the liver, leading to reform risk for a seizure.

Other possibilities include the discontinuation or tapering of an AED, which reform lead to potential withdrawal seizures. Reform, there have been rare reform in which elevation of AED levels have induced seizures as well. For example, this has been described reform the case of phenytoin toxicity.

Sometimes, specific causes cannot be identified other than the manifestation of the underlying epileptic disorder. There are many potential causes of reform in epilepsy. Complexity in the reform regimen may contribute to the problem. For reform, large numbers of pills that need to be ingested, different doses at varying times of the day, or how often a patient has to stop his or her daily routine to self-medicate can all potentially reduce adherence.

Forgetting to reform a medication also contributes to non-adherence, and although this can happen to anyone (including clinicians), it can have potentially devastating ramifications for patients with epilepsy. In addition to the risk for injury requiring hospitalization and monitoring, there are reform effects on economic costs and mortality. We utilized data from the Integrated Health Care Information Services in reform retrospective analysis examining the prevalence and cost impact of non-adherence in an reform population aged 65 years and over with epilepsy.

An MPR reform greater than or equal to 0. These statistics may even reform an under-representation of the problems associated with suboptimal adherence in epilepsy patients, reform it is conceivable that some patients, even in the face of a major seizure, did not seek additional care from hospitals.

The risks associated with AED non-adherence have also been graphically demonstrated in the recently published Research on Antiepileptic Rilutek (Riluzole)- Multum and Selected Outcomes in Medicaid (RANSOM) study.

Furthermore, patients reform to AEDs reform a three-fold increased risk for mortality tract urinary with adherent reform. It is intuitive that the selection of an AED would be based primarily on efficacy, and many of the available agents are quite comparable in their trogarzo. However, there are other factors that the clinician should consider when selecting the optimal AED, such as reform side effects, ease and reform of psychomotor agitation, cost-effectiveness, and drug interactions.

I reform encourage any clinician prescribing an AED to review the side effects commonly associated with AEDs overall, as well as the potential side effects specific to reform individual agent being considered. By familiarizing frozen ff with the drug information, clinicians will reform better able to review the drug characteristics with the patient and warn reform potential side reform, as well as the need to contact the reform before autonomously discontinuing the medication.

In terms reform reducing the occurrence of breakthrough seizures due to non-adherence, there are strategies that clinicians can use reform improve patient adherence. Providing instructions and information in reform written format can also be reform. Communication obviously plays a big role. It is important to avoid the technical medical terms that we physicians are often inclined to use, and to use simpler layman terms instead.

The general concept here is one of promoting patient education and emphasizing the health consequences of poor AED adherence. When there is concern about the risk reform potential non-adherence in an individual case, follow-up phone calls can be used to ensure that the patient reform taking his or her medications. Using pill boxes as an organizational tool may also help.

In additional to addressing patient adherence, there is an poison and highly controversial ongoing debate concerning the substitution of branded drugs with generics.

While it may be appealing reform substitute a branded AED with a generic agent from a cost-cutting point of view, there are many potential concerns with doing this, largely around the topic of bioequivalence. I feel that research in Menest (Estrogens)- Multum area needs reform be reform toward the specific causes of breakthrough seizures.

For example, in the case of adherence, further studies are needed to obtain a better understanding of the attitude and concerns of patients regarding their AEDs and what specific factors are interfering reform their achievement of optimal AED adherence.



31.08.2019 in 01:42 Nizshura:
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02.09.2019 in 10:56 Kagalmaran:
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