Besides requiring additional medical evaluation, patients with refractory seizures may benefit from education about seizure triggers and medication management. A research project funded by the Centers for Disease Control (Pugh et al, Neurology 2007;69:2020-7) developed a set of quality care measures pertaining to patients with refractory seizures. The following actions were rated as both valid and necessary indicators of quality care for patients with refractory seizures.

  1. IF the diagnosis or seizure type remains unclear after the initial evaluations, or the patient has recurrent seizures THEN the patient should be referred to the next highest level of epilepsy care.
  2. WHEN a patient with epilepsy receives follow-up care, THEN an estimate of the number of seizures since the last visit and an assessment of drug side effects should be documented.
  3. IF the patient reports unacceptable side-effects from AED monotherapy, THEN an alternative AED should be started (with carefully planned crossover).
  4. IF use of at least two different AED monotherapies has not resulted in seizure freedom, THEN referral for more highly specialized epilepsy care is indicated.
  5. IF a person with epilepsy is found to have evidence of a mood disorder (e.g., depression, anxiety) THEN s/he should receive treatment or a referral for mental health care.
  6. IF the patient continues to have seizures after initiating treatment THEN interventions should be performed.
    Options include:
    • Compliance assessment/ enhancement
    • Monitor AED blood levels
    • Increase AED dose
    • Change AED
    • Patient education re: lifestyle modification
    • Referral to higher level of epilepsy care

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Authored By: 
Steven C. Schachter MD
Authored Date: