RT Book, Section
A1 Jobst, Erin E.
A1 Panus, Peter C.
A1 Kruidering-Hall, Marieke
SR Print(0)
ID 1192815347
T1 Antiseizure Drugs
T2 Pharmacology for the Physical Therapist, 2e
YR 2020
FD 2020
PB McGraw-Hill Education
PP New York, NY
SN 9781259862229
LK accessphysiotherapy.mhmedical.com/content.aspx?aid=1192815347
RD 2024/04/19
AB CASE  STUDYC.M.  is  a  60-year-old  man  that  experienced  a  right  cerebrovascular  accident  15  months  ago,  with  resultant  left  hemiplegia.  He  initially  received  rehabilitation  in  an  acute  inpatient  facility  for  4  weeks  and  was  transferred  to  a  long-term  cognitive  rehabilitation  facility  for  approximately  8  weeks.  C.M.  made  significant  improvements  in  his  cognitive  and  speech  abilities,  but  he  was  still  nonambulatory  when  he  was  discharged  to  home.  Home  health  providers  felt  he  had  potential  for  additional  functional  return  and  referred  him  for  outpatient  physical  therapy.  C.M.  is  medically  stable  living  at  home  with  his  wife.  His  medications  include  escitalopram  (antidepressant),  pantoprazole  (proton  pump  inhibitor),  amlodipine  (calcium  channel  blocker),  warfarin  (anticoagulant),  valproic  acid  (antiseizure  drug),  and  lamotrigine  (antiseizure  drug).  C.M.  told  the  outpatient  physical  therapist  that  he  developed  a  seizure  disorder  poststroke  and  was  initially  treated  only  with  valproic  acid.  However,  he  had  breakthrough  seizures  and  lamotrigine  was  added.  C.M.  reported  that  he  had  his  blood  levels  of  warfarin  and  valproic  acid  checked  every  3  months.  After  2  months  of  outpatient  therapy,  the  physical  therapist  observed  that  C.M.  was  much  more  lethargic  on  several  consecutive  sessions.  He  began  to  require  multiple  rest  periods  during  treatment  sessions.  Communication  with  the  patient  was  difficult  as  his  speech  was  soft  and  muffled.  Notably,  there  were  no  new  sensory  or  motor  neurologic  signs  that  might  suggest  another  stroke.