Metabolism and Antiseizure Drugs

Abstract

A 57-year-old black male had hypertension, diabetes, end-stage renal failure, and was on hemodialysis (HD) three times weekly for 4 h. He was seen in the Emergency Department (ED) locally after presenting with a generalized seizure 3 h after arriving home from HD. His past medical history had included two similar generalized seizures. A first seizure occurred during HD. It was convulsive but was not treated because it was felt to reflect fluid and electrolyte shifts. The second one was considered an unprovoked seizure, though the patient declined treatment after an EEG was normal. He later insisted that it was provoked by his “medical condition.” On examination in the ED, he was lethargic but aroused to tactile stimulation. He was disoriented to date and person and confused about the situation. A relative weakness was present in his left arm and leg, and a posterior-lateral tongue laceration was present. He was given 1,000 mg of Levetiracetam (LEV) intravenously. Laboratory studies revealed a creatinine of 10.1 mmol/ml and blood urea nitrogen was 36 mmol/ml. Hemoglobin was 11.1 g/dl with hypochromic microcytic indices. MRI revealed subcortical white matter microvascular ischemic change. An electroencephalogram (EEG) and neurology evaluation were ordered, and he was admitted for further evaluation (Fig. 20.1).