Abstract
Intractable epilepsy can be divided into the following categories: epilepsy refractory to optimal treatment and epilepsy considered refractory but actually inadequately treated. It is important to assess the individual factors that contribute to making epilepsy refractory, because these factors differ between patients. We report on representative pharmaceutical care, in which a pharmacist assists an epileptologist at an outpatient clinic, to demonstrate the importance of pharmaceutical care in epilepsy treatment. The patient, a 29-year-old woman with a history of forceps delivery, first had a generalized tonic-clonic seizure (GTCS) at the age of 26 years. Several months before this first GTCS, she had had frequent sensory seizures characterized by numbness of the left arm. Magnetic resonance imaging revealed mild atrophy and broad degenerative changes in the white matter. Symptomatic localization-related epilepsy was diagnosed, but we had difficulty administering carbamazepine, zonisamide or valproate because they were poorly tolerated. We started treatment with phenytoin. The GTCSs were not controlled at a serum phenytoin level of 20μg/mL but were controlled at serum levels of 25 to 30μg/mL (275mg/day). However, the patient continued to have sensory seizures twice a month. As a result of consultation between the physician and a pharmacist, gabapentin was also prescribed. Although severe drowsiness developed in the first week after gabapentin was started, the patient could continue treatment by self-tapering the gabapentin dose as the pharmacist had instructed. This pharmaceutical care approach has greatly reduced the frequency of sensory seizures. Thus, it is critically important for pharmacists to administer pharmaceutical care in epilepsy treatment, particularly considering that drug administration is a core element of epilepsy treatment.
