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What to do when patients with epilepsy cannot take their usual oral medications
  1. Anna M Bank1,2,
  2. Jong Woo Lee1,
  3. Patricia Krause3,
  4. Aaron L Berkowitz1
  1. 1Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
  2. 2Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
  3. 3Department of Pharmacy, Brigham and Women's Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Anna M Bank, Department of Neurology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; abank{at}


When people with epilepsy are hospitalised for medical or surgical conditions, they may be unable to take their home antiepileptic drugs (AEDs). Such ‘nil by mouth’ people with epilepsy require alternative AED regimens to prevent breakthrough seizures. Here, we describe several strategies for maintaining seizure control in patients with epilepsy who have medical or surgical contraindications to their home oral regimens. These strategies include using non-pill oral formulations, using an intravenous formulation of the patient's home AED(s), using a benzodiazepine bridge and/or using alternative intravenous AED(s) when there are no intravenous formulations.


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  • Contributors AMB drafted and revised the manuscript. JWL, PK and ALB revised the manuscript.

  • Competing interests None.

  • Provenance and peer review Commissioned; externally peer reviewed. This paper was reviewed by Mark Manford, Cambridge, UK, and Sanjay Sisodiya, London, UK.

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