Keppra

[emilysmom,RN]

I have a new pt with mild MR and has seizures. He apparently gets seizures when he moves into a new situation such as being discharged from a Hosp or rehab.

Was discharged from Hosp due to having a grand mal seizure. Md put him on keppra while in Hosp. Had 2 seizures in 2 days. I contacted PCP when alf staff told me about them. PCP increased keppra to 3 times a day. The alf nurse is upset because he had a day without a seizure and md still increased it. She called me up at 8pm to ask me why was it increased. I think she was upset because I reported the seizures to him.

I feel that the MD needs to know about all seizure activity right?

[txredheadnurse, BSN, RN]

Yes the MD does need to know about seizure activity; especially after a medication change. How is else is he supposed to know if further adjustments need to be made? One day without seizures doesn't mean stop the meds. Rather it means the meds are probably working.

[KelRN215, BSN, RN]

If there was a rule that an MD needed to know about "ALL" seizure activity, some people would be calling their doctors hundreds of times a day. And no, that's not an exaggeration. My background is inpatient neurology and by no means did we advise people to contact the MD about all seizure activity. Every patient has a different baseline. Before I had my brain surgery, I had seizures every day and I never called my neurologist unless they were bad enough to send me to the ER. So with probably thousands of seizures in my life time, I called my doctor about it maybe three times. In the case described in the OP, if it's known that he typically has seizures when changing environments then I wouldn't have called the MD when he had a seizure exacerbated by changing environments.

Did they bother to check levels at all before increasing the dose? And WHY is a PCP managing the patient's anti-epileptics? That should be up to the neurologist. Keppra is typically not given TID and my guess would be that it's likely that the patient wasn't on a therapeutic dose.