Mike had had epilepsy since he was a child. When he was younger, he had lots of generalized tonic-clonic seizures, but new seizure medicines had kept them well controlled for the past few years. I met him when he was 22 years old. He worked full-time delivering supplies (driving a truck). A lot depended on remaining seizure-free. He volunteered to use one of the electronic bottles. He took his medication twice a day on about 80% of the days I observed for a few months. I asked him to continue using the bottle so I could get an idea of his consistency over a long time. Six months later, he called with an urgent problem: an unexpected generalized tonic-clonic seizure. Neither he nor the doctors could understand what had happened because he had been seizure-free for several years. The doctors wanted to bring him into the hospital for a full evaluation to find out what was happening. When I heard his story, I asked him for his electronic pill bottle. It contained the whole story:
|7:00 AM||6:45 AM||7:00 AM||9:45 AM||No AM dose||No AM dose||7:00 AM|
|9:15 PM||9:00 PM||9:15 PM||1:30 AM||No PM dose||Seizure at 7:00 PM
8:30 PM dose
What happened to Mike? It was clear that the medicine worked well to control his seizures when he took it regularly. But he was susceptible to seizures when his drug level was very low (such as after missing a few doses). Notice that he forgot both doses on Thursday and the morning dose on Friday. He had stayed up late watching a TV movie on Wednesday night. He was in a rush on Thursday morning, so he forgot his AM dose. After being late for work on Thursday, he worked late, came home very tired, and fell asleep on the sofa, forgetting his evening dose. Not being in his bedroom on Friday morning, he was off his routine for taking the morning dose. His family reported that the seizure occurred Friday evening after the TV news. When he recovered, he took the evening dose. He lost his drivers license and his job. That was his Titanic story.
There's more: He continued to use the electronic bottle. Eight months later, the same thing happened. He had another major seizure after missing several doses. I had a long talk with him about the need to be vigilant every day, 365 days a year, with no time off for good behavior.
There was no need for Mike to have a special neurological evaluation to understand why he had those "breakthrough" seizures. He did not need a higher dose, which might have caused side effects. He did not need to change to a different seizure medicine or to have a second one added to control his seizures. He just needed to be more careful about taking his medicine. That's why I say that everyone is Captain of his or her own ship.
What can you do to keep your ship afloat?
Why do people (like you and me) forget to take an important medicine? Even if you have a good system for taking your pills, "things happen" that can throw you off schedule. Most missed doses are simply overlooked or forgotten and you're not even aware of what happened. The event passes unnoticed. When you think about it later, you probably think you took the dose as usual. After all, if you forget a dose, you cannot remember that you forgot it!
Section Editor: Robert Fisher, M.D., Ph.D., author: Joyce Cramer
Last Reviewed: 11/15/08
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