Decreasing the Types and Quantities of Oral Antiepileptic Drugs Administered Alongside Intravenous Midazolam

It is reported that 0.4 to 0.8% of the world’s population suffers from epilepsy. About 30% of epileptic patients are intractable. Controlling their seizures is very important for society because many patients can participate in gainful employment. In this case study we report how we reduce and/or change the oral antiepileptic drugs (AEDs) taken (AED adjustment) by administering intravenous (IV) AED for an intractable epileptic patient. The patient was introduced to our hospital when she was 17 years old. She was born as a premature baby and had been suffering from partial seizures since she was 1 year old. We adjusted her oral AEDs in order to add newer AEDs, but the drugs did not work effectively. Thus, we hospitalized her in order to use continuous intravenous Midazolam (MDL) 0.1mg/kg/hr while we adjusted her AEDs. We were able to stop administering four out of five kinds of AEDs that the patient was taking simultaneously, without exacerbating her seizures. This case suggests that: 1) when intractable epileptic patients are taking a large number of oral AEDs, newer, additional AEDs cannot work effectively, and reducing the number of oral AEDs is crucial in adjusting their oral AEDs; and 2) IV AEDs enable a reduction in the number of oral AEDs in a short period of time without seizure exacerbation, thus facilitating safe adjustment of oral AEDs.