Multiple ASM Administration via Percutaneous Feeding Tube as a Cause of Pseudo-Refractoriness Leading to Recurrent Seizure Clusters.

It is important to identify true refractoriness of seizures, before escalation of anti-seizure medications, to avoid side effects of medications. Bioavailability of medications changes with the formulations used and changes significantly with the route of administration. Both of these were significantly impacted in a lady who was being fed via percutaneous endoscopic gastrostomy (PEG) feeds and deemed refractory to medications. After altering the formulations and the method, she became seizure-free.