It is challenging to discern whether consciousness disturbances experienced by an epilepsy patient are due to insufficient pharmacological activity of antiepileptic drugs or medication side effects. We treated an 82-year-old man with epilepsy who experienced a cerebellar infarction, followed by renal impairment due to a right renal infarction, and had decreased serum albumin levels. His consciousness disturbance persisted for more than two months. The disturbance improved one day after termination of levetiracetam administration. Re-administration of levetiracetam resulted in recurrence of consciousness disturbance. When carbamazepine was administered, he experienced consciousness disturbance despite a low blood concentration of 3.0 μg/mL. Drug-monitoring methods are well established for carbamazepine, but levetiracetam is a novel antiepileptic drug. This case report suggests that in patients with renal impairment and hypoalbuminemia, levetirace-tam and low doses of carbamazepine may cause sporadic adverse effects such as consciousness disturbance.
We aimed to investigate accessibility to epilepsy specialists in Japan using the Internet. We obtained a list of epilepsy specialists from the Japan Epilepsy Society website. The list contained the name, specialty, institution, and institutional address of each epilepsy specialist. We accessed each institution's website to determine the accessibility of information on epilepsy specialists in Japan. Nearly all hospitals and university hospitals had their own websites (99.6%), and most listed certified epilepsy specialists (81.3%). In comparison, fewer clinics and other institutions had their own websites (75.3% and 86.1%, respectively). Physician transfer and outdated website information were factors estimated to hinder access to correct information about epilepsy specialists. Our findings provide basic data regarding patients' access to information about epilepsy specialists on the Internet, which may help to improve accessibility for patients seeking certified epilepsy specialists. The data may also be helpful to clinicians who are involved in health care transition.