Author(s): Captain Manvikram Singh Gill
This is a case of breakthrough seizure and use of valproic acid (VPA) in management. Objective is to discuss the systematic approach in pharmacological treatment of epilepsy. Day one, patient was initiated with intravenous infusion of phenytoin 800mg, tablet phenytoin 300mg OD and tablet VPA 400mg TDS. Tablet VPA doses were withheld at Day 2 after Therapeutic Drug Monitoring (TDM) toxic levels. Patient was discharged with tablet VPA 400mg BD and tablet levetiracetam 500mg BD. In the beginning of therapy, a single pharmacotherapeutic agent is introduced cautiously to reduce any unwanted incidences of idiosyncratic and dose related toxicity. The pharmaco therapeutic agent dose must then be increased gradually to a maximum tolerated drug-dose therapeutic response. If this agent is not tolerated, it can be substituted with another agent for efficacious mono therapy. If seizures prevail, despite adequate trials of two appropriate agents, then poly therapy should be initiated. Patients need to be informed about the objectives of therapy and the risks and benefits of treatment.