Seizures in medically complex patients

Seizures are not an uncommon complication of medical conditions and should not be ascribed simply to "multifactorial" causes. Although many interacting factors may contribute to a lowered threshold for seizures, a careful systems-oriented search usually yields specific factors that are of primary importance. Not all medically complex patients with seizures have persistent or irreversible processes that lead to recurrent seizures or a need for maintenance antiepileptic drugs (AEDs). Because AEDs contribute to the potential for drug interactions, side effects, and toxicities in situations already encumbered with significant polypharmacy, the decision not to initiate such therapy can be even more important than selecting the best agent, best route of administration, and best dose from a growing list of AEDs.