Shri Vishnu College Of Pharmacy

CASE PRESENTATION

Presented by:
S. Siva Kumar Reddy,
VI/VI PHARM-D,
614175802021.
EPILEPSY
 It is a disorder characterised by recurring
seizures
 A Seizure is a brief, temporary disturbance in
the electrical activity of the brain
 Seizure is a symptom of epilepsy
NOCTURNAL EPILEPSY
 Nocturnal epilepsy is a seizure disorder in
which seizures occur only while sleeping
 One of the most common seizure triggers for
many people with epilepsy, is sleep
deprivation
 Nocturnal seizures are a risk factor for Sudden
Unexpected Death in Epilepsy (SUDEP)
A male patient of age 28 years was admitted into
the hospital

Reason for admission:

• Two episodes of seizures in sleep with no

regain of consciousness in between
• Involuntary movements of both upper and
lower limbs
• Bed wetting
• Bitting the tongue in sleep
Past Medical History: Noctural Seizures

Past Medication History: Not Available

Past Surgical History: Not Available

Family History: Not Available

Social History
• Locality : Bhimavaram.
• Occupation : Cultivation.
• Smoking : No
• Alcohol : No
• Diet : Mixed
• Marital Status : Married
General Physical Examination
DESCRIPTION DAY 1 DAY2

BP (mmHg) 130/80 120/80

RR(breaths/min) 22 18
PR(bpm) 90 87
TEMP(ºF) 98.6 98.6

• CVS : S1 S2+
• R/S : Clear
• P/A : Soft
• SPO2 : 100%
• Height : 172 cm
• Weight : 75 kg
• BMI : 25.42 ( OVERWEIGHT)
 SOAP NOTE
Subjective Evidence
• Two episodes of seizures in sleep with no
regain of consciousness in between
• Involuntary movements of both upper and
lower limbs
• Bed wetting
• Bitting the tongue in sleep
 Objective Evidences
Lab parameters:
Parameter Normal Range Day-1

Hb 11.5 - 16.5g/dL 15.2g/dL

Neutrophils 2.0 - 7.0×10⁹/L 6.3×10⁹/L

Platelets 150 - 450 ×10⁹/L 320×10⁹/L

Na 135-145 mmol/L 136 mmol/L

K 3.4-5.0 mmol/L 4.4 mmol/L

Serum creatinine 0.6-1.2 mg/dL 1.3mg/dL

RBS 200 mg/dL 153 mg/dL

Radiological Evidence

• CT Scan and ECG – it showed that there is

no significant abnormality.

• Advised Sleep Deprived EEG - it showed

positive results for Nocturnal Epilepsy
 Assessment
Diagnosis:
From subjective evidence and past
medication history, the patient was diagnosed
as nocturnal epilepsy.
 Goals of treatment:
• General goals:
To improve the quality of life of the patient
To improve mental health of the patient

• Patient specific goals:

To reduce the seizures frequency and severity
To treat the patient with out adverse effects
Plan
Brand Name Generic Name ROA DOSE FREQ DAY 1 DAY 2
INDICATION
Antibiotics

Inj. Monocef Ceftriaxone i.v. 1g BD ANTIBIOTIC Y

Other
medications

Tab . Oxetol Oxcarbazepine p/o 150mg BD SEIZURES Y Y

Tab. Clobazam Clobazam p/o 10mg OD SEIZURES Y Y
Tab. Ultracet Tramadol p/o 1 Tab SOS PAIN Y Y
Inj. Diazepam Diazepam i.v. 10mg OD ANXIETY Y
Inj. Levipril Levetiracetam i.v 500mg OD SEIZURES Y Y
Inj.Pantocid Pantaprazole i.v 40mg OD ACIDITY Y Y
Mida Spray Midazolam IN 0.5mg SOS SEIZURES Y
 Discharge medications
BRAND NAME GENERIC NAME INDICATION DOSE FREQ DURATION

Tab. Oxetal Oxcarbamazepine Seizures 150mg BD 2 days

Tab. Clobazam Clobazam Seizures 10mg OD 5 days

Tab. Ultracet Tramadol Pain 100mg OD SOS

Mida Spray Midazolam Acute repetitive 0.5mg SOS SOS

seizures
Pharmacist Interventions

A) Adverse Drug Reactions: Not found

B) Drug – Drug Interactions

 Diazepam Midazolam (MAJOR)
Concurrent use of MIDAZOLAM and CNS DEPRESSANTS
may result in increased risk of hypoventilation, airway
obstruction, desaturation, or apnea
 DIAZEPAM TRAMADOL (MAJOR)
Concurrent use of TRAMADOL and CNS
DEPRESSANTS may result in increased risk of
respiratory and CNS depression
C) Medication Errors
 Inappropriate drug - Tramadol which was given for
pain can induce seizures
Alternate : Pregabalin and Gabapentin
I suggest gabapentin for neuropathic pain over
pregabalin as it cause weight gain
Gabapentin - 300mg –TID
 Indication without drug – Patient had a symptom of
bed wetting. To treat the condition, I suggest
Desmopressin
55.3 mcg sublingually (without water) once daily, 1
hour before bedtime 
PATIENT COUNSELLING
Non Pharmacological Plan
o Maintain proper sleeping cycle
o Take Ketogenic Diet – Eggs, Green Leafy Vegetables, Nuts, Meat
o Take Vitamin B12 rich foods – Milk, Eggs, Chicken, Fish
o Avoid stress conditions
o Make sure that the patient sleeps on the floor
o Avoid driving and swimming alone .
Medication Counselling
Oxcarbazepine
 As it is a drug that affects CNS, we need to instruct
the patient’s attenders to consult the doctor if they
find any unusual behaviour
 The drug may cause dizziness and somnolence, so the
patient should be advised to avoid activities
requiring mental alertness or coordination until drug
effects are realized
 It is better to take the drug at night
 The drug has a chronic side effect of hyponatremia,
therefore advise the patient to take spinach, carrot
Clobazam
 Advise the patient to consult the physician, if he finds
any dermatological reactions( any skin problems)
 Advise patient against sudden discontinuation of drug
as this may increase seizure frequency
Midazolam
 Advise patient to report symptoms of respiratory
depression
References
• Pharmacotherapy Handbook- Dipiro
• Micromedex – app.
• Medscape.
Thank you…