Seizure disorders can negatively impact an individual’s life and are associated with high morbidity and mortality rates if not well-controlled. This neurological condition affects anyone regardless of age, race, social class, etc. According to Johnson (2018), a seizure is a sudden alteration in neurological function due to abnormal and excessive discharging of neurons in the brain. There are two major classifications for seizures, and their symptoms are dependent on the area of the brain in which they originate. The first group, known as generalized seizures, comprises absence and tonic-clonic seizures while the second group, focal seizures, consists of simple, complex, and secondary generalized seizures.
Absence seizures (petit-mal) is a sudden and brief lapse in one’s consciousness and lasts approximately 5-30 seconds (Barone et al., 2020). Interestingly enough, children are more susceptible to these types of seizures and may outgrow them later in life (Barone et al., 2020). Unlike other seizures, absence seizures do not have a postictal phase due to their short duration and symptomology: smacking one’s lips, fluttering of the eyes, chewing movements, or rubbing fingers together (Crunelli et al., 2020). Tonic-clonic seizures (grand-mal) involve the loss of consciousness and may include prodromal symptoms that occur hours to days prior to seizure onset (Beniczky et al., 2020). During this timeframe, individuals can exhibit confusion, anxiety, irritability, anger, headache, confusion, or other mood disturbances (Beniczky et al., 2020). While the convulsion occurs, patients may cry or fall to the ground as a direct effect of bilateral, symmetrical contractions to muscles, as well as bite their tongue and/or have urinary incontinence (Arcangelo et al., 2022). On the other hand, simple focal seizures (partial) occur while a person is awake and alert and can sometimes progress to a generalized tonic-clonic seizure. People often experience various sensory and autonomic symptoms and emotional changes, and even describe different smells or tastes before the seizures begin (Wang et al., 2017).
Antiepileptic medications are used to prevent future seizures from occurring; however, their undesired side effects that could make compliance an issue for patients. More often than not, individuals taking these medications may experience fatigue, confusion, poor coordination or balance, and blurry vision (Ayalew & Muche, 2018). Valproic Acid (Divalproex/Depakote) can be used as monotherapy, and adjunctive therapy for people who have seizure disorders (specifically generalized, focal, and absence) and is considered first-line treatment in these cases (Arcangelo et al., 2022). Although it is an excellent choice for the management of this condition, valproic acid has several adverse effects, including a black box warning that warrants close monitoring in patients with a history of liver disease. Hepatotoxicity may result in addition to other side effects such as GI upset, alopecia, behavioral changes, weight gain, pancreatitis, and thrombocytopenia (Arcangelo et al., 2022). Moreover, women of childbearing age should not take this medication due to the teratogenic risks that may ensue after its use (Arcangelo et al., 2022). Patients should receive education that routine monitoring of valproic acid levels in the blood is required to maintain a therapeutic level.
Levetiracetam (Keppra) is another anticonvulsant that is approved for adjunctive treatment in adults with focal, myoclonic, or generalized tonic-clonic seizures (Arcangelo et al., 2022). Like Depakote, this medication is categorized as broad spectrum, meaning it may be used for a wide range of different types of seizures. Unlike the latter, however, patients do not have to have levels monitored, which may be helpful in some cases. A key point to note is that the liver does not metabolize Levetiracetam, nor does it bind to proteins making it less likely to have any significant interactions with other prescribed medications. Regardless, adverse effects still exist, such as somnolence, headache, asthenia, irritability, and mood changes (Arcangelo et al., 2022).