ANTIEPILEPTIC DRUGS B

rief History. F.B. is a 43-year-old man who works in the shipping department of a large company. He was diagnosed in childhood as having generalized tonic-clonic epilepsy, and his seizures have been managed successfully with various drugs over the years. Most recently, he has been taking carbamazepine (Tegretol), 800 mg/d (i.e., one 200-mg tablet, qid). One month ago, he began complaining of dizziness and blurred vision, so the dosage was reduced to 600 mg/d (one 200 mg tablet tid). He usually takes his antiseizure medication after meals. F.B. also takes an antihypertensive (lisinopril, 10 mg/day) and a cholesterol-lowering drug (simvastatin, 20 mg/day). Two weeks ago, he injured his back while lifting a large box at work. He was evaluated in physical therapy as having an acute lumbosacral strain. He attends physical therapy daily as an outpatient. Treatment includes heat, ultrasound, and manual therapy, and he is also receiving instruction in proper body mechanics and lifting technique. F.B. continues to work at his normal job, but he avoids heavy lifting. He attends therapy on his way home from work, at about 5:00 p.m.

Problem/Influence of Medication. F.B. arrived at physical therapy the fi rst afternoon stating that he had had a particularly long day. He was positioned prone on a treatment table, and hot packs were placed over his low back. As the heat was applied, he began to drift off to sleep. Five minutes into the treatment, he had a seizure. Because of a thorough initial evaluation, the therapist was aware of his epileptic condition and protected him from injury during the seizure. The patient regained consciousness and rested quietly until he felt able to go home. No long-term effects were noted from the seizure.

1. What factors may have precipitated F.B.’s seizure?

2. What precautions can be taken to prevent additional seizures and guard against injuries if a seizure occurs during a rehabilitation session?