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For pharmacist-recom- mended products, go to OTCGuide.net. MORE @ OTCGUIDE. NET W WATCH DISEASE STATE MANAGEMENT Epilepsy Children Who Undergo Epilepsy Surgery May Struggle Academically A lthough brain surgery is a common option for patients with epilepsy who do not respond to medication, a recent study has found that chil- dren who undergo this procedure may experience dif- ficulties in school afterward. The study, published in Epilepsy & Behavior, examined the arithmetic, spelling, and reading comprehension abilities of 136 children aged 5 to 18 years who had undergone resective epi- lepsy surgery—a procedure that removes a part of the brain in order to reduce seizures—between 1995 and 2013. All of the participants had completed standard- ized tests before and 14 months after the surgery, with many of the children underachieving in at least one area on the presurgery evaluation; this was consistent with previous findings in which children with epilepsy were determined to be at higher risk of having cogni- tive problems in areas such as language, problem solv- ing, learning, and memory. Most of the children fared even worse on the post- surgery test, with many participants' scores in reading, spelling, and numeral operations dropping 2 to 10 points. This suggests that although brain surgery may successfully stop seizures, it will not necessarily improve the academic performance of patients with epilepsy, according to the study authors. "The surgery stops the seizures, but it's not like we put a new brain in there. These children still have a preexisting brain abnormality," said lead author Mary Lou Smith, a psychology professor at the University of Toronto, in a press release. "What I think is happening now is as they're getting older, they're not progressing at the same rate their peers are progressing, and so as a result of that, over time, you see these lower scores because the difference between their performance and what's expected given their increasing age is widening," Smith added. The study authors acknowledged that they cannot yet determine if the lower test results were due to the surgery, the epilepsy, or the children's development, but noted that their findings may help the families of patients with epilepsy decide whether surgery is the best choice for their child. "This is a tremendously challenging decision for par- ents, and they want to know the risks and benefits," Smith stated. "I think this information is very important for health care providers if they're counseling patients and for pursuing evidence-based practice." Epilepsy Treatment Should Immediately Follow First Seizure A guideline recently released by the American Academy of Neurology (AAN) and the American Epilepsy Society has clarified that antiepileptic medication should be administered immediately after a patient's first seizure in order to reduce the risk of having another seizure within 2 years. The guideline, presented at the AAN's 67th Annual Meeting and published in Neurology, is the first to address treatment of a first seizure in adults. According to the guideline, adults who have had a first seizure face a 21% to 45% increased risk of another seizure in the 2 years follow- ing the incident. This risk is greatest among patients with a previous brain injury, such as a stroke, tumor, or head trauma, as well as in those with a significant abnormality on imag- ing tests of the brain. However, the guideline revealed that immediate treatment with an antiepileptic medication can lower the risk of another seizure by 35% within these first 2 years. "Determining whether to treat a patient after a first seizure is a complex process, but this guideline supports the use of medication in some cases and could influence standard prac- tice for many physicians," said the guideline's author, Allan Krumholz, MD, in a press release. "A single seizure could be a sign of epilepsy. Even 1 seizure is traumatic and can affect many aspects of an individual's life, from driving a car to employment options. This guideline clarifies when a person's risk for another seizure war- rants medication." The guideline stated that 7% to 31% of patients who are treated with antiepileptic medication will experience an adverse effect (AEs) related to the drug, but noted that these AEs are typically mild and can be reversed when the dose is lowered or when a patient is switched to a different medication. The guideline also acknowledged that although immediate antiepileptic treatment can yield a short-term benefit, it is unlikely to have a long-term effect on whether a patient remains seizure-free. n Patients appreciate pharmacists' recommendations on health care resources and products. Go to Cou-Co.com for easy access to coupons, co-pays, and educational tools. December 2015 PharmacyTimes.com 85