Abstracts

Rationale: The availability of pharmacologic expertise and access to consultation with a clinical pharmacist with training in epilepsy is included as an essential service of Level 3/Level 4 specialized epilepsy centers that offer extended video-EEG (vEEG) monitoring. We describe the role of the clinical pharmacist at such a center and propose a protocol that utilizes a systematic approach to obtain and evaluate AED history in order to ensure safe AED withdrawal and to maximize optimal outcomes during admissions. We also review the outcomes of AED withdrawal in 10 patient cases utilizing the services of a clinical pharmacist at our center.Methods: Patients are referred for elective admission to the Epilepsy Monitoring Unit (EMU) for extended vEEG monitoring. Prior to admission, the clinical pharmacist contacts the patient via telephone to obtain a brief pre-admission AED history. 5 essential components are obtained during the phone interview: 1) AED(s) the patient is currently taking and at what time; 2) Current AED serum levels; 3) Description of patient s predominant seizure type; 4) History of seizure triggers; 5) History of clustering or status epilepticus. The clinical pharmacist evaluates the current AED therapy and current drug levels. Based on AED half-life, mechanism of action and history, a tentative AED withdrawal plan is determined after discussion with the admitting epileptologist. During admission, the clinical pharmacist is also available daily to discuss changes to the treatment plan, ensure medication safety, and to address any medication questions or medication administration issues.Results: Ten recent patient cases were reviewed. AEDs were successfully and safely withdrawn in all ten patient cases. Clinical seizures with evidence of correlating epileptic electrographic activity were captured in three cases in which complete withdrawal of AEDs was not necessary to elicit seizures. In 2 of 3 cases, seizures occurred after sleep-deprivation and in the third case, seizures occurred after hyperventilation. In all three of these cases, seizures occurred during hospital day 3 or hospital day 4 of a six day admission. Non-epileptic seizures or no seizures were observed in the other seven cases. In six of these seven cases, AEDS were tapered off completely by hospital day 2, 3, or 4 with no complications. AEDs were restarted on hospital day 4 or day 5 with recommendations from the clinical pharmacist. All patients were discharged on hospital day 5 or day 6 in good condition.Conclusions: Epilepsy management calls for a collaborative interdisciplinary team approach including the participation of a specialized clinical pharmacist who can provide pharmacologic expertise. This is especially evident at Level 3/Level 4 centers where AEDs are routinely withdrawn during extended monitoring. At such a center, clinical pharmacists can play an active role in obtaining patient AED history, assessing the AED treatment withdrawal plan and ensuring the safety of the patient and best outcomes.