From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Admission to the hospital should be considered for patients with a history of seizures who have experienced a seizure after missing their antiepileptic medication (AED) if they have prolonged recovery, new neurological findings, significantly sub-therapeutic drug levels, inadequate home support, or inability to obtain medications promptly after discharge. When evaluating these patients in the Emergency Department (ED) setting, several key factors should be considered, including seizure severity and post-ictal state, medication adherence patterns, home support system, new neurological deficits, and precipitating factors beyond missed medication 1. Laboratory studies such as electrolytes, glucose, toxicology screen, and anticonvulsant levels are essential in determining the underlying cause of the seizure and guiding management decisions 2.
Some key points to consider when evaluating these patients include:
- Assessing seizure severity and post-ictal state, with admission warranted for prolonged seizures (>5 minutes), status epilepticus, or significant alteration 1
- Determining medication adherence patterns and reasons for missed doses to predict future risk 3
- Evaluating the patient's home support system and ability to reliably resume medication 3
- Considering new neurological deficits that may indicate a new lesion requiring imaging and admission 1
- Assessing for precipitating factors beyond missed medication, such as infection, metabolic abnormalities, or substance use 2
If the patient has returned to baseline, has a reliable way to resume medication, shows no new neurological findings, has therapeutic or near-therapeutic drug levels, and has adequate home support, outpatient management with close follow-up (within 1-2 weeks) may be reasonable 1. However, the decision to admit or discharge should be made on a case-by-case basis, taking into account the individual patient's needs and circumstances, with the goal of minimizing morbidity, mortality, and improving quality of life 1.