A 23-year-old male with a history of localization-related epilepsy was taking Carbamazepine, 400 mg PO BID. His epilepsy would manifest as recurrent focal seizures that intermittently progressed to convulsions. He was seizure-free as long as he remained compliant with his AED. He was reported to have recently been away on a camping trip with several of his friends. While he was away, he was sleep-deprived due to staying up until late hours of the early morning. Shortly after midnight he developed a "grand mal" seizure. This repeated two more times and his friends called 911 for help. He was transported to the nearest hospital and had persistent impairment of his consciousness. In the Emergency Department (ED), he did not answer questions and was "just staring at the nurses". A brain CT was unrevealing. Laboratory evaluation did not demonstrate any abnormalities in his electrolytes or complete blood count with differential. A toxicology screen was negative for illicit substances and alcohol. A carbamazepine level was non-detectable.
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