From the Guidelines
Initial investigations for a 16-year-old male with two seizures should include a comprehensive neurological evaluation, blood tests, and neuroimaging, with a brain MRI being the imaging study of choice to identify structural abnormalities, as recommended by the American College of Radiology 1. The patient should undergo an electroencephalogram (EEG) to detect abnormal brain electrical activity, complete blood count, comprehensive metabolic panel including glucose, calcium, sodium, and magnesium levels.
Key Investigations
- Electroencephalogram (EEG) to detect abnormal brain electrical activity
- Complete blood count
- Comprehensive metabolic panel including glucose, calcium, sodium, and magnesium levels
- Brain MRI to identify structural abnormalities, including coronal T1-weighted imaging, high-resolution volume acquisition, and coronal T2 and fluid-attenuated inversion recovery sequences 1
Safety Considerations
Safety considerations are paramount and include seizure precautions such as:
- Avoiding heights
- Swimming alone
- Driving
- Operating dangerous machinery The patient should be evaluated for antiepileptic medication, with levetiracetam (Keppra) often prescribed as first-line therapy at an initial dose of 500 mg twice daily, potentially increasing to 1000-1500 mg twice daily based on response and tolerability 1.
Education and Follow-up
Medication adherence is crucial, as sudden discontinuation can trigger seizures. The family should be educated on seizure first aid: placing the patient on their side, removing dangerous objects, not restraining movements, and not putting anything in the mouth. School personnel should be informed about the condition and emergency protocols. Regular follow-up with a neurologist is essential to monitor medication effectiveness and side effects. These measures are necessary because two unprovoked seizures meet the clinical definition of epilepsy, requiring comprehensive management to prevent further episodes and ensure patient safety, as defined by the International League Against Epilepsy 1.
From the FDA Drug Label
Patients, their caregivers, and families should be counseled that AEDs, including levetiracetam, may increase the risk of suicidal thoughts and behavior and should be advised of the need to be alert for the emergence or worsening of symptoms of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts, behavior, or thoughts about self-harm Patients should be advised that levetiracetam may cause changes in behavior (e. g. aggression, agitation, anger, anxiety, apathy, depression, hostility, and irritability) and in rare cases patients may experience psychotic symptoms.
The initial investigations for a 16-year-old male with two seizures should include a thorough medical history, physical examination, and laboratory tests to rule out any underlying conditions that may be causing the seizures. Key considerations for safety include:
- Monitoring for suicidal thoughts and behavior
- Watching for changes in behavior, such as aggression, agitation, or depression
- Advising the patient not to drive or operate machinery until they have gained sufficient experience on levetiracetam to gauge whether it adversely affects their performance of these activities 2 2
From the Research
Initial Investigations
- For a 16-year-old male with two seizures, initial investigations should include a thorough medical history, physical examination, and laboratory tests to identify any underlying causes of the seizures 3.
- Electroencephalography (EEG) and epilepsy protocol-specific magnetic resonance imaging (MRI) of the brain are essential to determine the risk of recurrence and the need for long-term treatment 3.
- The EEG can help identify any abnormal electrical activity in the brain, while the MRI can help identify any structural abnormalities that may be contributing to the seizures.
Safety Considerations
- When considering antiepileptic medication, it is essential to take into account the patient's comorbidities, adverse effect profile, and type of epilepsy 3.
- The choice of medication should be carefully selected to minimize the risk of adverse effects and optimize seizure control.
- Valproate, lamotrigine, and levetiracetam are commonly used antiepileptic medications, but their efficacy and safety profiles may vary depending on the individual patient and the type of epilepsy 4, 5, 6, 7.
- For example, valproate is effective for generalized tonic-clonic seizures, but it may have a higher risk of adverse effects, such as teratogenicity, particularly in women of childbearing age 4, 5, 7.
- Levetiracetam and lamotrigine may be suitable alternatives to valproate, particularly for patients with partial onset seizures or those who are of childbearing age 5, 7.
Treatment Options
- The treatment options for a 16-year-old male with two seizures will depend on the underlying cause of the seizures, the type of epilepsy, and the patient's individual needs and circumstances.
- A careful evaluation of the patient's medical history, physical examination, and laboratory tests, including EEG and MRI, is necessary to determine the best course of treatment.
- The patient should be counseled on the risks and benefits of antiepileptic medication, as well as the importance of adherence to the treatment regimen and follow-up appointments with their healthcare provider 3.