Case Study

A 28 year old RH Haitian F had drug-resistant localization-related epilepsy.  She failed multiple AEDs and was admitted for status.  Family members were not present when she presented on CBZ and VPA to disclose a history of PHT allergy. She was admitted to the ICU and loaded with PHT.  No untoward adverse effects resulted and her seizures became controlled.  She was maintained on 700 mg of PHT daily with levels that averaged 14 ug/dl.  She unexpectedly after being seizure free for nearly 2 years presented to the ED with complaints of dizziness, malaise, incoordination, and blurry vision.  She was seen in follow-up after release.  A PHT level was 8 ug/dl in the ED and no seizures had been reported.  On presentation to epilepsy clinic she kept complaining “these are not my pills”.  A bag with multiple generic drugs was encountered below.

Figure: Multiple PHT generics: red, white, grey-white, and a bottle with grey-white  (bottom) and white colored capsules (top). It is legal for a pharmacy to dispense a combination of different colored medications in 1 pill bottle  to a patient!

What was the issue with the AEDs? Click here for answers and discussion.

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