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Child having simple partial seizures. Swallowing with a frown on the face. Done with CT scan and EEG. Took tegretol. Advise?

DOCTOR OF THE MONTH - Nov 2013
Nov 2013
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Neurologist
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Hello
I have a daughter age 4 years and weighing 17 kilos, several months ago began to get her simple partial seizures (focal), and the symptoms: My daughter feels like a swallow food, bitter, and begins swallowing with a frown on the face, without losing consciousness or fall or even stiffness in muscles and the duration of seizure approximately 15 seconds (see video). In the beginning and in the worst cases of disease my daughter was gets her case every half hour, and could not sleep because of it. CT scan and EEG were clean (good) , then we started use Tegretol 2%, reaching the dose to 15 ml twice a day ,but the seizure does not stop! Seizure became gets her once a week (the drug level of Tegretol in the blood reached to 5.31). Then the Neurologist reduced the Tegretol to 13 ml and ‏ added KEPPRA at a dose of 2.5 ml twice a day, but still those seizures get her every week!!
1- Are the diagnosis and the treatment correct? What have to do to stop the seizures?
2-Is it really that cases of seizures like my daughter be the most difficult in the treatment than the case of seizures with loss of consciousness?
3 - What is usually the cure rate of this type of seizures at the kids?
4– Does the condition could be worse if my daughter left the treatment?

Thank you
#Note (Not published)
This video camera for my daughter and her condition, please do not publish it, I attached it for only seen by a doctor (the duration of each clip less than a minute)
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Posted Tue, 17 Sep 2013 in Brain and Spine
 
 
Answered by Dr. Sudhir Kumar 6 hours later
Brief Answer:
Current medical treatment is correct

Detailed Answer:
Hi,

Thank you for posting your query.

It is unfortunate that your daughter's partial seizures are not yet controlled. These type of seizures are common, and get controlled by medications in about 70% of cases.

Initially, a single medicine is started, and the dose is gradually increased to the maximum tolerated dose. If seizures are not controlled, then, the second drug is added, and the dose gradually increased to maximum tolerated dose. In your daughter's case, I have noted that tegretol and Keppra have been used, which are good choices for focal onset seizures.

As the seizures are not yet controlled, the third anti epileptic drug can also be added. This third drug can be lamotrigine or sodium valproate. As I mentioned, about 70% of children would get controlled with three medications. However, about 30% of them would not have adequate seizure control with medications.

They would require further evaluation, such as MRI epilepsy protocol with 3.0 tesla MRI, PET scan of brain, prolonged video EEG recording, etc. I a seizure focus is identified in the brain by these studies, then, the child could be considered for epilepsy surgery.

I hope it helps. I would be pleased to answer any follow up queries.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist,
Apollo Hospitals, Hyderabad
Above answer was peer-reviewed by
 
Follow-up: Child having simple partial seizures. Swallowing with a frown on the face. Done with CT scan and EEG. Took tegretol. Advise? 2 days later
Thank you for your reply
1- Does the condition could be worse if my daughter doesn't eat the medicine? Could the case convert to complex seizures focal for example?
2-The duration between Tegretol dose and KEPPRA dose is 30 minutes, is this an appropriate period of time? (Ex: she takes Tegretol at 11 AM and then she takes KEPPRA at 11:30 AM)
3-if the seizures do not stop, should we stop the medicine?
4-Does my daughter have seizure focus in her brain because she has simple partial seizures, or you don’t know until we make MRI?
5-If my daughter has seizure focus in her brain and we will not do any surgery for her, what are the disadvantages of this decision?
6- If my daughter does not have seizure focus in her brain, and the medicine does not stop the seizures, what we can do?
7- If my daughter grew up and married, do these medications can effect on her pregnancy? Or effect on her in any way?
8-Are there any tips other than drugs can reduce the case of my daughter, a particular food?Or use sand?Or a particular system?
Thank you
 
 
Answered by Dr. Sudhir Kumar 9 hours later
Brief Answer:
Answers are below in detail

Detailed Answer:
Thank you for getting back and asking more questions. Following are the answers.

1. If the medicines are not used, then, the number and severity of seizures may increase.

2. The gap of 30 minutes between tegretol and Keppra dose is adequate.

3. If seizures do not stop, then, options are to change the dose of medicines or use different drugs.

4. Seizure focus is always in brain. Tests such as MRI, video EEG and PET scan help in finding out the location of focus in brain.

5. Surgery is required in only selected cases of epilepsy, when medical treatment fails. Not doing surgery in those cases would mean that the seizures continue in the child.

6. As I said, seizure focus is always in the brain. And if medicines do not control seizures, surgery is the option, based on other tests.

7. Medications are safe in pregnancy, if taken under medical supervision.

8. Other measures include adequate sleep, eating food on time, avoiding stress, etc.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
Follow-up: Child having simple partial seizures. Swallowing with a frown on the face. Done with CT scan and EEG. Took tegretol. Advise? 22 hours later
Thank you for your reply

1-What is the maximum allowable dose of Keppra for my daughter (4 years and weighing 17 kilos) ?

2-If my daughter continues to take medication and the seizures stop for 2 years , what is the percentage to heal so that they leave all these drugs?

3- In most cases, at any age is cured of this case?

4- When I talk to my daughter during seizure ,she can respond to me , is this enough proof to diagnosis her case at simple not complex ? because actually I don't know if she remember what I said to her during seizures or not

Thank you
Best wishes,
 
 
Answered by Dr. Sudhir Kumar 8 minutes later
Brief Answer:
Answers are given below

Detailed Answer:
Thank you for getting back.

1. Maximum dose of Keppra is 50 mg per kg body weight, so, in your child's case, it would be 17X50=850 mg per day, given in two divided doses.
2. We normally recommend medicines for three seizure-free years. About 70% children become seizure free in that period and are able to stop medications.
3. As I said, 70% get cured after three years of medications, but the rest 30% need to take it lifelong.
4. Based on the description, she most likely has simple partial seizures.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
Follow-up: Child having simple partial seizures. Swallowing with a frown on the face. Done with CT scan and EEG. Took tegretol. Advise? 14 hours later
Sorry for bothering you
Please look at to white lines in the belly of my daughter

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Is it a sign of something or is it normal?
In fact, I do not remember if it existed before the drugs or not. But the pediatrician scared me today, because he took a long look at these lines but he did not say any comments!!
Thank you
 
 
Answered by Dr. Sudhir Kumar 47 minutes later
Brief Answer:
Could not open that link

Detailed Answer:
Hi,

Thank you for getting back. As I could not open that link on my iPad, I request you to upload the picture here on XXXXXXX

Thanks and best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
Follow-up: Child having simple partial seizures. Swallowing with a frown on the face. Done with CT scan and EEG. Took tegretol. Advise? 3 days later
Hello,
1- I attached the picture that contains white lines, please see it
2- The pediatrician said that in common cases, if the first medication (Tegretol) could not control the seizure, then the other one like Keppra will could not!! Is that true?
Actually keppra did not control the seizures until now, and we have an appointment with Neurologist tomorrow and maybe he will increase the dose
3- The pediatrician advised us to ask the Neurologist to replace the Keppra with Topamax .He said “it is better than Keppra because Keppra have more side effect than Topamax”, what do you think?
4-during my daughter's seizure, I could talk with her and she Respond to me .In most of seizure I hug her. But I read a lot about the power of unconscious mind, and I think if I request her to change her movement (for example: I clap or out my tongue and then ask her to mimic me) . just for Distraction and exit her from seizure , I think this is may be help her in the future to control the seizure by herself and I hope that help her to left the medications also (I'm optimistic). What do you think? Is my thinking true or wrong?
5- In the last three weeks, I noticed that my daughter hallucinating immediately after her seizure. The hallucinations period is less than half a minute; she starts talking about the strange things were not talking about it before the seizure. What is that? Is it normal? Is it from medications as side effect? Or her seizure became worse?
6- The Pediatrician said: “as long as her seizure is simple and not lose the awareness, it is better for her health and her liver to use only Tegretol (13 ml ) for whole her life than use 3 medications for two or three years. What do you think?

Thank a lot
 
 
Answered by Dr. Sudhir Kumar 10 hours later
Brief Answer:
Answers are below.

Detailed Answer:
Thank you for getting back.

1. Pictures show no significant abnormality.
2. No, it is not true. If one medication does not work, the second one could work in many cases.
3. Both keppra and topamax are good options, I prefer keppra.
4. Medications are required for good seizure control.
5. These symptoms can occur as part of seizures.
6. The choice of medications and duration depends on the type of epilepsy, side effects, EEG and MRI findings.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
Follow-up: Child having simple partial seizures. Swallowing with a frown on the face. Done with CT scan and EEG. Took tegretol. Advise? 24 hours later
Hi
Thank you for your reply
1-Could you tell me please why you I prefer keppra more than topamax ?
2- I know that the medications are required for good seizure control but when I asked you about stopping the seizure by using unconscious mind, I did not mean she will leave the medications. I meant if I talk to her during her seizure and ask her for doing something, is this could hurt her?
Should I leave her until the seizure finish? Or can I do my attempted to break the seizure by asking her to do anything else? I hope you understand me

3-I hear that IPad (or any tablet) and mobile could be increase the epilepsy? Or decrease the Efficiency of medications. Is this true?
4-if the answer of question 3 is true, what is the maximum number of hours that can the child spent it in playing with these electronic machine in a day?
5- Does that include TV and laptop?

6-in general, Does these electronic machine cause cancer for child or adult?
7- Same question 4 but related to question 6
8- Same question 5 but related to question 6

Thank you
 
 
Answered by Dr. Sudhir Kumar 3 hours later
Brief Answer:
Answers are below

Detailed Answer:
1. Keppra is more effective than topamax in seizure control.
2. Attempting to speak during seizures will not hurt her.
3. Ipad and mobile would not increase her epilepsy.
5. Similarly, TV and laptop are also safe.
6. Electronic machines are safe for use by her.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
Follow-up: Child having simple partial seizures. Swallowing with a frown on the face. Done with CT scan and EEG. Took tegretol. Advise? 40 hours later
Thank you
We visited the Neurologist yesterday, and he said: reduce Tegretol from 13ml to 10 and increase Keppra from 2.5ml to 3ml
And when I asked him why Tegretol should be reduced? He said: In some cases, the reduction of the dosage of the drug could be more effective
What do you think? Is that true?

 
 
Answered by Dr. Sudhir Kumar 7 hours later
Brief Answer:
Dose changes may help

Detailed Answer:
Thank you for getting back.

Dose reduction is done, if we are suspecting certain side effects due to tegretol. So, the doctor may have reduced the dose as he would have seen side effects due to tegretol.

So, please follow the advice of doctor.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
Follow-up: Child having simple partial seizures. Swallowing with a frown on the face. Done with CT scan and EEG. Took tegretol. Advise? 43 hours later
Did you mean that the neurologist may saw the side effects of tegretol on my daughter but did not tell us?
The Neurologist examined my daughter only clinical examination, did not do a blood test two months ago
 
 
Answered by Dr. Sudhir Kumar 5 hours later
Brief Answer:
Yes

Detailed Answer:
The only reason to reduce the dose of tegretol is to minimise the side effects.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
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