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48 Month Child Suffering From Seizures. On Different Medicine. Are These Medicine Safe?

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Posted on Sun, 18 Nov 2012
Question: Hi my daughter (Age 48 month, currently weighing 14kg) is a patient and has been detected with convulsion. In a day she used to get 25-30 seizures, each seizure took 5 to 7 sec. in starting period, now after a long treatment she is getting 4-5 seizures every day. These days we have noticed increase in number of convulsion attacks with the intensity increased, as a matter at fact since last couple of weeks we have noticed her falling down often and getting injuries/causalities..

The sequence of events that occurred along with medications prescribed are as follows.
1. On 15-January-2010, she developed her convulsions. CT scan done, no problem identified; but doctor prescribed 2.5 ml of valparine two times daily
2. In March problem grew then we met with the doctor and she recommend tagrital 2.5 ml in morning and 5 ml in evening instead of valparine 2.5. She told us to stop valparin in reducing rate and called us for follow-up in 2 week with EEG.
3. After one week problem grew more and she was falling down oftenly then we consult doctor and she prescribed tagrital 5 ml in morning anf 7.5 in evening.
4. Problems became worst. Then we met with another doctor for second opinion, who prescribed valprine 2.5 ml in morning and 2.5 in evening and she started Prolognum injection two month course in which she prescribed 60 unit for 15 days then 40 unit for another 15 days and then 20 unit for another 15 days and then 20 unit alternate days for another 15 days. During injection my daughter was very dull and aggressive, but her convulsion was reduced. But after stopping the injection ther problem was as like as previous one.
5. As the symptoms did not get controlled doctor put her on valprine 5 ml in morning and 5 ml in evening with 1/4 th of nitravit in evening.
6. After one month valprine dosage remained the same, but nitrvit was replaced by Sabril with increasing rate in every 7 days (1/4---->1/4 - 1/4----->1/2- 1/4----->1/2- 1/2---->1/2- 3/4---->3/4- 3/4------->1- 3/4---->1- 1----> 1)
7. After another 2 month valprin syrup is replaced with valprin 200CR table and sabril and colba 5. She is taking Cobla 5, one tablet in the evening.
8. After 4month Sabril replaced with Colba 10 mg. current dose is
morning:- Valprin 220cr + colba 5mg and Rabacon1/4th
evening: - Valprin 220cr and colba 5mg and Rabacon1/4th

Past and birth history: She was born by forceps assisted vaginal delivery at term. She was in the ICU for a couple of days following delivery. According to her doctors (though we do not have the reports) no major events followed birth.

Family History: No one else in the family suffer from seizures

Investigation details: I have attached a document for your reference. Details are available in the attachment.

Current status of daughter is: -

Still she is very dull and aggressive but her convulsion was reduced. (4 to 5 in a day)
She is not able to talk and not able to walk properly. (Speech and occupational therapy is going on)

Irritations and aggressiveness is high.
not able to concentrate on objects.

Last mint we have done the EEG and Report says: -
{Abnormal awake + Sleep inter – ictalteg Recorded , Because of general leased IED’S}

Attachment option is not there so could not able to send you the report. if required I can send you on mail.

Doctor,

1. I am looking for second opinion.
2. Am I going to right direction towards treatment?
3. All the prescribe medicine is ok with dose?
doctor
Answered by Dr. Neeraj Baheti (17 hours later)
Dear Mr XXXXXXX
From the description you have given, your child has epileptic encephalopathy.
the medication trial is most appropriate according to the EEG and the seizure description u have given. The current doses are appropriate.
I have few more queries. What sort of seizures the child is currently having. Are the same type or different type. Can you describe the seizure in details or upload a video.
You have written 4-5 seizure daily. Are the as a cluster in morning or spread throughout the day.
Can you send me MR imaging findings, metabolic work up if it is done. I am unable to see your attached file.
There are few more medications which can be tried if your child is unresponsive to the current treatment.

Best Wishes,
Neeraj


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Neeraj Baheti (48 hours later)
Thanks sir for your prompt response.

answer of your query: -
1. 4 - 5 seizure is daily with same type. and it is not a cluster mode. means whenever seizure comes her eyes start blinking for around 4-5 second in one phase.
attaching you the video with all medical report and MR report also.
Attached video has been taken when we identify the object with issue.
the same kind of seizure behavior is coming now. do let me know if you required fresh video.
Sir,
also request you to give the valuable comment on
1. aggressive and dull behavior.
2. She is not able to talk and not able to walk properly (balance problem).
3. IQ level is very low.
Is all the thing are recoverable with growing age.
currently we are sending her in to play school.....


Kindly suggest.
doctor
Answered by Dr. Neeraj Baheti (4 hours later)
Dear Mr. XXXXXXX
I wen thru the attachments. The episodes look like complex partial seizures Vs. complex absences. EEG shows generalised epileptiform abormalities.
For her problem in walking and low IQ, she has delayed milestones. We expect she should slowly improve with medications and neurocognitive rehabilatation. But how much how early only time can tell.
For her aggression small doses of medications like risperidone can be tried in consulatation with your epileptologist. What is this Rabacon? Is it revocon?
Continue same line of treatment. If she still continues to get these episodes, in future she can be subjected to repeat Video-EEG to see her EEG patterns and if possible record one of these episodes. This will certainly help in selection of medications.
Should you have any more queries, feel free to consult. By the way, your baby is in best hands. Just continue as per advise of your epileptologist

Best wishes,
Neeraj
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Neeraj Baheti (46 minutes later)

yes sir,It is it revocon?

Thank You for your guidance. I really appreciate it.you make me understand my situation better. I specially thanks to you and Health-magic team for prompt response .
doctor
Answered by Dr. Neeraj Baheti (21 hours later)
Dear Mr. XXXXXXX
If still these movements persist, the child can be subjected to repeat short term video EEG with an aim to record these events. This would help us for selecting further medications. At the back of my mind although very unlikely there was thought that could it be non epileptic movements and hence i asked about revocon. Don't worry your baby is with the best epileptologist.
If u dont have any more queries, you can close the discussion.
Feel free to ask if you have any query in future

Best wishes
Neeraj
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
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Dr. Neeraj Baheti

Neurologist

Practicing since :2000

Answered : 37 Questions

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48 Month Child Suffering From Seizures. On Different Medicine. Are These Medicine Safe?

Dear Mr XXXXXXX
From the description you have given, your child has epileptic encephalopathy.
the medication trial is most appropriate according to the EEG and the seizure description u have given. The current doses are appropriate.
I have few more queries. What sort of seizures the child is currently having. Are the same type or different type. Can you describe the seizure in details or upload a video.
You have written 4-5 seizure daily. Are the as a cluster in morning or spread throughout the day.
Can you send me MR imaging findings, metabolic work up if it is done. I am unable to see your attached file.
There are few more medications which can be tried if your child is unresponsive to the current treatment.

Best Wishes,
Neeraj