MEDICAL TREATMENT OF SEIZURES: COMMON QUESTIONS ABOUT BLOOD LEVELS – BLOOD LEVEL HAS SLIPPED BELOW THE THERAPEUTIC’ RANGE
“Sally had several grand mal seizures and was placed on a medicine. She has had no more seizures since age three, but she has grown and gained weight. Her physician finds that Sally’s blood level has slipped below the therapeutic’ range. What should he do?”
This question of maintaining the level over time also needs to be addressed. In Sally’s case there are two alternatives. The physician could increase the dose, and thus the blood level, to keep it in the therapeutic range giving her greater protection against another seizure. Or he could leave the dose alone, let it gradually continue to decrease as she grows, and when she has been free of seizures for two years, then he can discontinue the medicine. There is not, however, necessarily a correct thing to do. Children who have been free of seizures for two years can discontinue medication with a high probability of remaining seizure free. That chance is higher if the blood levels are low at the time the medicine is stopped because a child who is sensitive to the level of medication is more likely to have a seizure when the level drops below the therapeutic range. Then the doctor increases the dose and waits another two years. If the child is unlikely to have another seizure, then it doesn’t matter if the blood level is low. Allowing the level to drop slowly is a form of testing. If Sally passes the test, her chance of having a seizure when we stop the medicine is low. If she fails the test and has another seizure, we believe that it is better for this to happen at a younger age. Therefore, our suggestion to this parent and this physician would be not to increase the medicine. We believe that the risks and consequences of another seizure at this age are outweighed by the possible side effects of a higher dose on Sally’s learning capacity. Other physicians (and other parents) may believe differently.
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