January 2025
In this VETgirl online veterinary continuing education blog, Dr. Missy Carpentier, DACVIM (Neurology) details the suggested follow up blood work needed when a patient is prescribed anticonvulsant drugs to control seizures. Continued monitoring and evaluation of patients on anti-seizure medications helps ensure they are on the road to good seizure control and improved quality of life.

Anticonvulsant Drug Monitoring

By Dr. Missy Carpentier, DACVIM (Neurology)


Your epileptic patient just left the hospital, you have your anti-seizure medications prescribed, and you are feeling pretty good. Then you remember, you didn’t set up an appointment for the follow up blood work that is needed. But what blood work is needed, when is it needed, and is it necessary? Read along to find out!

Image by Dave Boardman from Pixabay

The ultimate goal for every epileptic patient is good seizure control with a good quality of life. We do our best to control the frequency, duration and severity of seizures with anticonvulsant medications. Currently, the most commonly prescribed anticonvulsant medications are phenobarbital, potassium bromide, levetiracetam (regular and extended release), zonisamide, and pregabalin. I have included a chart below that will help you determine when you should be collecting drug blood concentrations and if any other blood work is recommended. It should be noted that regardless of what medication a patient is receiving, I always recommend a yearly CBC and chemistry profile.

Image by Shameer Pk from Pixabay

Each and every patient needs to be looked at individually and it is important to recognize that despite what the number is that you receive on your drug blood concentration, you need to correlate it to the patient. How are BOTH the patient and the owner handling the side effects of the medication, how is their seizure control, etc. Values for one patient may work great and for another the side effects may be significantly affecting their quality of life, and therefore adjustments need to be made. It is also important to recognize that the “therapeutic range” of a drug is just that, a range. A value in the therapeutic range doesn’t mean that you still cannot increase or decrease the dose of the medication, and it also doesn’t mean that you have maximized the potential of that drug.

Below is a chart that will help you with monitoring the drug blood levels of your patients and any other necessary blood work that is recommended. Remember, seizure management is an art and no two patients are alike! (click on the chart for a larger view)

 


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