Pharmacologic management of seizures in organ transplant

Seizures in a transplant candidate or recipient raise complicated management issues, but there are no results from controlled drug trials to guide their pharmacologic treatment. Most seizures in the transplant population are isolated events that do not require long-term antiseizure therapy. Short-term therapy, however, can reduce seizure recurrence. This review focuses on the pharmacologic management issues associated with acute and short-term therapy of seizures in this population. Phenytoin, fosphenytoin, and phenobarbital are current first-line therapies. The interactions between immunosuppressants and these antiepileptic drugs (AEDs) are of particular importance because the latter may reduce immunosuppressant blood levels. Other, newer agents are not subject to this interaction, and further studies are needed to define their role in the management of seizures in transplant patients.