Epilepsy   

Is there a role in adjusting the medication doses to levels in seizure-free patients; or is it sufficient to just monitor patients clinically?

In light of the publication of results from the EPISODE study.

Is there any concern for drug interactions of DMARDs and/or biologics with anti seizure medications?

E.g., nasal, rectal, buccal.

How would you counsel the patient given the drug interactions present?

I.e., 20 minutes vs 30 minutes vs 1 hour.

How does the 2HELPS2B scoring tool play a role in your decision-making?

See Benbadis, AAN Commentary February 2023; 13 (1).

Many recent studies cast doubt on continuous vs repeated routine EEG.

If the patient is in burst-suppression once EEG is connected, how long do you keep patient in burst-suppression before weaning sedation?

Or love to share personal experiences/articles?

How do you recommend titration?

For example, a patient with 2 Hz GPDs with hepatic or uremic encephalopathy.

What are some high-yield instances where triphasic waves on electroencephalogram (EEG) are more than just harmless markers of gross toxic-metabolic en...

Should one restart lamotrigine or look for an alternative? If no other alternative available, is slow titration vs regular titration preferred?

If so, for how long?

While it is an excellent score for objectively assessing concerning EEG features, there are pathologies where it can be argued that long-term monitori...

With studies showing rare risk of developing epilepsy after PRES do you just taper medications over the following weeks-months? Any need for outpatien...

(e.g. Alzheimer's disease)?

What are your thoughts on the ethics of inpatient use of sedatives in these patients to help with agitation to “protect themselves from harm and...

Occasionally, patients referred for dedicated epilepsy management for "medication refractory epilepsy" are found to have purely non-epileptic spells. ...

This question is intended to include consideration of cardiac diagnostic screening, as well as initiation & maintenance of lamotrigine, in epileps...

How can one safely taper off and stop clonazepam in a woman of reproductive age with epilepsy who is taking it chronically for epilepsy and is plannin...

The thought being, if no clearly defined lesion exists on available neuroimaging, how do we balance the benefits, risks, and uncertainty in choosing w...

By completely unremarkable, I mean zero clinical events AND zero interictal abnormalities despite full withdrawal of medications. Assume, for the sake...

How do you treat refractory focal status epilepticus in an adult with history of alcoholism and traumatic bilateral subdural hematomas who is failing ...

What is the your preferred loading (and maintenance) dose for use of Perampanel in the treatment of refractory status epilepticus?

The question is broad and is meant to include patients who have healthy BMD, osteopenia, and osteoporosis, as well as exposure to first generation AED...

Is there an AED of choice?

In patients undergoing continuous EEG monitoring in the ICU, we often encounter EEG patterns that lie along the inter-ictal continuum (IIC). In such c...

What steps should be taken to wean them off?