A difficult pill to swallow? Improving outcomes in epilepsy using sodium valproate

Abstract

Epilepsy is associated with considerable avoidable mortality and morbidity, however, optimal treatment could potentially halve current mortality rates. Numerous factors contribute to suboptimal management including, as illustrated in this review, poor adherence, an inadequate number of specialist nurses and weaknesses in the evidence base. Recent studies establish valproate as a first-line option for several seizure types. Neurology nurses can use the number of valproate formulations available to help address issues such as side effects, problems with swallowing and poor adherence. Furthermore, once-daily evening dosing may protect against the many seizure types that are more likely to start and/or generalize during sleep. While this review considers valproate, the principles discussed apply to other anti-epileptic drugs (AEDs). This article illustrates that a multifaceted, interdisciplinary approach that considers the most appropriate AED and optimal formulation for each patient should help epilepsy specialist nurses (and nurses with an interest in neurology) further reduce the morbidity and mortality associated with epilepsy.