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Prescribed Anticonvulsant Medications and the T&D directive

Question# 799

As per the treat and discharge - seizure considerations it states “the patient is taking their anticonvulsant medication as prescribed”, but what if the patient isn’t prescribed any anticonvulsant medications? Is it still considered treat and discharge, or is it a patient refusal?

For further clarification I was on a call where the patient had experience a seizure, they met all the conditions as stated in treat and discharge other than they did not specify if they are epileptic or suffer from psychogenic nonepileptic seizures. They simply stated they are not on anticonvulsant medication due to not having a family doctor (is on the wait list).

Answer:

Firstly, it is possible to have epilepsy or a seizure disorder and not be on medications, however these are often patients diagnosed with drug-resistant epilepsy. There are other treatment modalities being utilized by some patients but there is still a significant lack of evidence and research surrounding them. They include epilepsy surgery, vagus nerve stimulation, deep brain stimulation and responsive cortical stimulation. Therefore, for patients that are diagnosed with epilepsy and are being treated by a neurologist or other specialist and are prescribed not to take any medications this could be considered a Treat and Discharge, however a consult patch with a Base Hospital Physician is required as it is outside of the directive.

Secondly, regarding the specific patient encounter you had where they could not confirm an official diagnosis of epilepsy, then this would not be considered a Treat and Discharge and would be a refusal if the patient was adamant about not going to hospital. However, a patient that had or is having a seizure and is not being medically managed or followed for this medical condition should be seen by a physician at the hospital. “There is evidence that seizures cause brain injury, including neuronal death and physiological dysfunction” (Sperling, 2004). At the hospital they will be able to do bloodwork, investigations, continuously monitor, possibly provide anti-epileptic medications, and initiate neurology follow-ups as necessary if another seizure were to occur.

In conclusion if the patient falls outside of the ALS PCS directive for Treat and Discharge, have a consult patch with a BHP for further discussion about the patient and their situation.

References

Schachter, A. C. (2022). Overview of the management of epilepsy in adults. UpToDate. Retrieved from https://www.uptodate.com/contents/overview-of-the-management-of-epilepsy-in-adults?search=epilepsy&source=search_result&selectedTitle=2%7E150&usage_type=default&display_rank=2

Sperling, M. (2004). The consequences of uncontrolled epilepsy. 98-101. doi:10.1017/s1092852900008464

Published

01 May 2024

ALSPCS Version

5.3

Views

83

Please reference the MOST RECENT ALS PCS for updates and changes to these directives.