How should antiseizure medications be managed if a patient with epilepsy is undergoing surgery or has a fever?

• A. Continue daily meds as usual; use IV formulations if NPO; monitor interactions and adjust as needed with medical team.
• B. Stop all antiseizure medications during surgery to avoid interactions.
• C. Only use herbal remedies during fever.
• D. Significantly increase the dosing without consultation.

Answer: (A)

Maintaining continuous antiseizure therapy around surgery or during fever is crucial. The aim is to keep therapeutic drug levels to prevent breakthrough seizures and withdrawal, which can complicate perioperative care and illness. If the patient can take medications by mouth, continue the daily regimen as prescribed. When oral intake isn’t possible (for example, NPO status during surgery), switch to available IV formulations so treatment isn’t interrupted, and work with the medical team to adjust dosing as needed to maintain seizure protection. Be mindful of potential interactions between antiseizure drugs and anesthesia, antibiotics, or IV fluids, and adjust only under supervision. Abruptly stopping medications or markedly increasing the dose without clinical guidance can provoke seizures or cause toxicity. Fever and illness can change metabolism and hydration status, so ongoing maintenance therapy should be preserved with careful monitoring and appropriate adjustments by the care team.