The neurologist usually is asked to consult on patients with renal disease and seizures for two reasons:1,2

1. Seizures associated with renal insufficiency, hemodialysis, or both
• Seizures are associated with four conditions occurring with renal insufficiency:3
• Uremic encephalopathy
• Dialysis disequilibrium syndrome
• Aluminum encephalopathy syndrome
• Dialysis encephalopathy syndrome (dialysis dementia)
2. Management of antiepileptic drug therapy in patients with renal disease
• The complex issues encountered in this situation require expertise in two areas:
• Effects of renal insufficiency upon drug pharmacokinetics
• Effects of hemodialysis upon drug pharmacokinetics
• Effects of renal insufficiency and hemodialysis upon the pharmacokinetics of specific antiepileptic drugs

Adapted from: Browne TR. Renal disorders. In: Ettinger AB and Devinsky O, eds. Managing epilepsy and co-existing disorders. Boston: Butterworth-Heinemann; 2002;49-62.
With permission from Elsevier (www.elsevier.com).
Reviewed and revised February 2004 by Steven C. Schachter, MD, epilepsy.com Editorial Board.