2. Starting the consultation
2. Starting the consultation
A number of ASMs are used for other conditions so it is important to ask the patient why they are taking the medication.
If this is the first time an ASM has been prescribed for epilepsy, you may find that the patient is still a little stunned by the diagnosis as it can have devastating effects on their life. Having to give up driving and possible alterations to employment can be far-reaching in impact.
It is useful to explain to the patient the purpose and likely length of the consultation you are about to have. Suggested talking points at the start of the consultation include explaining your role with regards to counselling about new medicines (including NMS where relevant) and ongoing support.
If this is the first time an ASM has been prescribed you might ask:
- How the epilepsy was diagnosed
- What has already been discussed at hospital appointments regarding diagnosis, treatment and prognosis
- What the patient has been told about the medicine(s). Bear in mind that information may have been forgotten or misremembered.
Two other medicines that may be prescribed are benzodiazepines: clobazam or buccal midazolam
Often prescribed as a ‘rescue’ remedy alongside ASM
This might be used to help patients where there are known intermittent triggers for seizures (e.g. menstrual periods, exam stress). It might also be used, for example, while waiting for the level of the first-line ASM to be titrated up or when one ASM is being titrated out due to side-effects and the level of the second agent has not reached the therapeutic range.
Some patients will be on it long-term, although drowsiness and tolerance can be an issue
Used for the prevention and treatment of status epilepticus, a medical emergency resulting from prolonged or continual seizures.
Needs to be administered by a trained carer if the patient’s seizure has not stopped after five minutes and should always be prescribed by brand (Epistatus or Buccolam) as the carer will have been trained to use one product
Reflection exercise
Visit Epilepsy Society and other epilepsy charities and familiarise yourself with the resources available for both patients and healthcare professionals.