eMedicine Specialties > Neurology > Seizures and Epilepsy

Complex Partial Seizures: Follow-up

Author: Anthony M Murro, MD, Laboratory Director, Professor, Department of Neurology, Medical College of Georgia
Contributor Information and Disclosures

Updated: Oct 11, 2006

Follow-up

Patient Education

  • Patients with complex partial seizures is advised not to drive, operate potentially dangerous machinery, or perform any other activities that would put themselves or others at risk of injury from a seizure.
  • Every woman of childbearing potential should be given detailed information about the risks and benefits of anticonvulsant therapy, including the increased risk of congenital malformations and the need to take daily multivitamins and folate 1-5 mg/d.
  • For excellent patient education resources, visit eMedicine's Brain and Nervous System Center. Also, see eMedicine's patient education article Epilepsy.

Miscellaneous

Medicolegal Pitfalls

  • Clinicians should document in writing that they have advised the patient not to operate a motor vehicle or dangerous machinery or to perform any other activities that would put the patient or others at risk of injury from a seizure. Clinicians should be familiar with regulations regarding driving in the states in which they practice.
  • Clinicians should document in writing that they have advised every woman of childbearing potential on the risks and benefits of anticonvulsant therapy, including the increased risk of congenital malformations and the need to take folate 1-5 mg/d.
  • Clinicians should document that they have advised women on the risk of oral contraceptive failure that may occur with hepatic enzyme inducing anticonvulsants.

Special Concerns

  • The benefits of controlled seizures outweigh the risks of drug therapy during pregnancy.
  • The risk of congenital malformations is increased 2-4 times with anticonvulsant therapy during pregnancy.
  • During pregnancy, a woman with epilepsy should receive the minimum dose and the minimum number of anticonvulsants that can control her seizures.
  • Supplementary folate 1-5 mg/d is recommended for all women of childbearing age who take anticonvulsants.
  • Phenytoin, phenobarbital, topiramate, and carbamazepine may cause oral contraceptives to fail.
  • The best anticonvulsant during pregnancy is the one that best controls the patients' seizures. Valproate has a higher risk of congenital malformations compared with that of other anticonvulsants. Lamotrigine does not appear to increase the risk of congenital malformations.
  • A common error during pregnancy is to switch the anticonvulsant to an apparently safer anticonvulsant though the patient's seizures are well controlled.
  • Use of enzyme-inducing anticonvulsants, particularly phenobarbital, may increase the risk of perinatal hemorrhagic complications. Supplementary vitamin K 10 mg/d is recommended during the last month of pregnancy.
  • The risk of congenital malformations increases during the switch-over period, when the mother is exposed to 2 anticonvulsants.
  • Changing the mother's current anticonvulsant to one that is less effective in controlling seizures may harm the mother and the baby.
 


More on Complex Partial Seizures

Overview: Complex Partial Seizures
Differential Diagnoses & Workup: Complex Partial Seizures
Treatment & Medication: Complex Partial Seizures
Follow-up: Complex Partial Seizures
Multimedia: Complex Partial Seizures
References
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References

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Further Reading

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Keywords

attacks, convulsions, fainting, spells, impaired consciousness, simple motor automatisms, manual automatisms, oral automatisms, perseverative automatisms, bizarre automatisms, temporal lobe complex partial seizures, parietal lobe seizures, frontal lobe seizures, extratemporal lobe seizures, occipital lobe seizures, complex partial status epilepticus, sudden unexpected death in epilepsy, SUDEP, brain trauma, encephalitis, meningitis, stroke, perinatal brain injuries, vascular malformations, cortical dysplasia, neoplasms, febrile seizures, temporal lobe epilepsy, mesial temporal sclerosis

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Contributor Information and Disclosures

Author

Anthony M Murro, MD, Laboratory Director, Professor, Department of Neurology, Medical College of Georgia
Anthony M Murro, MD is a member of the following medical societies: American Academy of Neurology and American Epilepsy Society
Disclosure: Nothing to disclose.

Medical Editor

Joseph F Hulihan, MD, Vice President, Medical Affairs, Ortho-McNeil Janssen Scientific Affairs, LLC
Joseph F Hulihan, MD is a member of the following medical societies: American Academy of Neurology, American Clinical Neurophysiology Society, American Epilepsy Society, American Headache Society, and American Medical Association
Disclosure: Johnson & Johnson Salary Employment; Johnson & Johnson Stock Employment

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

CME Editor

Matthew J Baker, MD, Consulting Staff, Collier Neurologic Specialists, Naples Community Hospital
Matthew J Baker, MD is a member of the following medical societies: American Academy of Neurology
Disclosure: Nothing to disclose.

Chief Editor

Nicholas Y Lorenzo, MD, Chief Editor, eMedicine Neurology; Consulting Staff, Neurology Specialists and Consultants
Nicholas Y Lorenzo, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Neurology
Disclosure: Nothing to disclose.

 
 
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