While seizure patients are often treated with common antiepileptics such as phenytoin and levetiracetam, those with severe refractory disorders may be treated with less frequently used medications such as felbamate.
Felbamate is reserved as monotherapy or adjunctive therapy for refractory, partial seizures in adults with or without secondary generalized seizure, and as adjunctive therapy for children with partial and generalized seizures due to Lennox-Gastaut Syndrome (condition that causes seizures and developmental delay).
In patients who present to the ED on felbamate, consider checking a CBC with differential and liver function tests, as it can cause aplastic anemia (relatively rare but 30% fatal) and liver damage (rare but 40% fatal), respectively.
Signs and symptoms of aplastic anemia include: fever, sore throat, chills, other signs of infection, bleeding, easy bruising, extreme fatigue, weakness, or lack of energy.
Signs and symptoms of liver failure include: nausea, extreme fatigue, unusual bleeding or bruising, lack of energy, anorexia, right upper quadrant pain, jaundice, or flu-like symptoms.
