|Current attitude to epilepsy management avoids use of blood level determination, a position which may be appropriate in stable situations. Despite this, use of blood levels may have a definite role in managing cluster seizures. Cluster seizures are a medical emergency treated with short acting benzodiazepines (BDZ) and longer acting anti-epileptic medications (AEM). Blood levels of the longer acting AEM may assist management decisions. AEM blood levels allow confirmation of adequate dosage and repeated treatment if the levels are sub-therapeutic. Current opinion in the treatment of epilepsy is to avoid the use of blood level determination and to rely almost exclusively on the clinical picture. This presumes a stable patient without fluctuations in seizure expression or changes in anti-epileptic medications (AEM), which may not always be apparent, as may be the case with generic substitution.
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