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Neurocysticercosis Cured After Medication. Stopped Taking Eption. Any Precaution To Be Taken?

Posted on Sat, 30 Mar 2013

Question: Dear Doctor, I need your kind advice and for following issue of mine. Following is my short summary of treatment. I am 39 year old Man, during my study days around 21 year ago I was suffered from seizures and approached to Nurom Specialist in P.G.I . Lucknow. After Head Xray and EEG Doctor start giving me AED Tageratol 300 mg but Seizure not fully controlled later on he changed the medicine to Phenytal 30 mg - 3 tablets a day. When again seizure not fully recovered Nuro Doctor advice Contrast CT SCAN Brain and reports diagnose me with neurocysticercosis, then Doctor advice me 2 Tab Albendazole for 3 months every morning along with Eption 100 Mg - 3 Tablets in night and after 3 months on Doctor advice another CT Scan done and reports are almost normal then Doctor advice to stop taking Tab Albendazole and keep continue Eption 100 Mg - 3 Tablets in night. Later on after 3 years [Seizure Free] I shifted to Delhi but Eption 100 mg - 3 Tablets continue taking in night. Then I have contact to another Nurologist in Delhi, he again advice the CT Scan and reports were normal hence he advised to reduced the Eption gradually by 3 Tablets to 2 Tablets and I continue taking 2 Tablets of Eption 100 mg then after 1 year Tablet reduced to 1 Tablet Later on again after 2 years I shifted to Mumbai due to my service transfer but now I continue the Eption 100 Mg - 1 Tablet every night. Since I am living seizure free from past 18 years apx and having much active life (Doing Driving 100 Km a day, Swimming, Horse Riding ,Rock Climbing etc, also taking Hard Drinks 4 -5 Large Pegs twice in week ), but still taking Eption 100 Mg - 1 Tablet every night , hence to stop medicine again I contact to Nuro Specialist in Mumbai he gone through my medical history and advice Test, after reviewing latest MRI / SCAN reports , which are normal, Doctor advice me to stop taking Eption 100 MG One Tablet straightaway. So regarding this I need your suggestion and opinion. Now almost 12 days passed , since I stopped taking one Tablet of Eption 100 Mg, and feeling comfortable but little bit worrying seizure recurrence and and feeling headche. Is any chance of recurrence of fits after stopping medicine, and precautions should be taken by me in social and office life now I am living normal much active stress full life and working as Sales Head in Steel Mill for Western India.

Answered by Dr. Gopal Krishna Dash (5 hours later)

Hello,

Thanks for the query,

I am an Epilepsy specialist responding to you,

Before i respond to the query that you have posted, let me tell you that the general principle of medication with drawl in patients with epilepsy are 1. seizure freedom of about 3-4 years in adults 2. Normal examination findings 3. Normal Electroencephalogram (a test which can tell the brain function and predict the chance of seizure recurrence)

Overall in any epilepsy, the chance of recurrence of seizure after medication withdrawal varies between 10-30%. The risk of recurrence in patients with neurocysticercosis is very low.

Back to you, I have noted your problem and I have gone through the reports attached. In your case the chance of recurrence is very low and you just relax. It is advisable that you get an Electroencephalography done (preferably with a sleep tracing). If it comes normal, the chance of relapse will be negligible.

Just relax and do not worry. If can do the EEG, it is better for my guidance.

Hope I have answered your query,
Please let me know if you any other query in this issue.

Best wishes

Dr Gopal K Dash
Consultant Neurologist and Epilepsy specialist XXXXXXX Hrudalaya hospital, Bangalore

Above answer was peer-reviewed by : Dr. Mohammed Kappan

Follow up: Dr. Gopal Krishna Dash (2 hours later)

Thanks Doctor,

I will do EEG TEST in Mumbai, should I need any priscription for that or can do with our priscribe by Doctor.

Also before stoping Eption I used to take Hard Drinks twice in a week from past 20 Year which I never stop, should I need to avoid Alcohal and if yes then up to how much time?

Please suggest.

Answered by Dr. Gopal Krishna Dash (1 hour later)

Hello,

Thanks for the writing back.

Your doctor will help you in the EEG test. He/she will write a prescription for you.

Please note that alcohol reduces the threshold for seizures and more so in susceptible individuals. With your background I will advise you to adhere to a good life style in order to prevent future relapse of seizures. Best will be to completely abstain from alcohol.

Best wishes,

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Gopal Krishna Dash (11 hours later)

Thanks Doctor,

I spoke to my Nurologist at Mumbai but he is advising that since I am seizure free from past 18 years and recent MRI / CT are clear hence EEG not require.

He already checked me activities - ovements in OPD and said EEG not require, infect at their Jupiter Hospital XXXXXXX EEG facility is available.

Please suggest what should we do ?

Answered by Dr. Gopal Krishna Dash (16 minutes later)

The decision between physicians can differ in these types of cases. I suggested based on the general set protocol used while withdrawing antiepileptic drug.

The options are left to you.

If you want to take my opinion as you are form India, you are most welcome.

BEST WISHES

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Gopal Krishna Dash (9 hours later)

Thanks Doctor,

For betterment of my active life I have decide to follow your openion for EEG in tomorrow morning with sleep tracing, Doctor advice me to awake 2 - 3 hours early from routine schedule in morning.

Also give me Nasal Sprey INSED for emergency use in case of recurrence.

Is it ok, plz suggest.

Answered by Dr. Gopal Krishna Dash (2 hours later)

Hi,

Yes, it is ok. You can follow the advice.

Best wishes,

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Gopal Krishna Dash (16 hours later)

Dear Doctor,

As suggested EEG done by me by and findings are here.

EEG obtained with 10-12 system of electrode application.
Patient was awake during recording.
Background activity consist of alpha activity at 9 Hz occipital regions.
12-13 Hz beta activity was seen over frontal regions.
There were a few right parietotemporal sharp waves.
Activation procedures were uneventful.

Impression :-
This is mildly abnormal EEG with right parietotemporal abnormalities.

Please correlate clinically.

So Doctor please suggest your opinion on this report.

Answered by Dr. Gopal Krishna Dash (6 minutes later)

Hello,

Thanks for the feed back

I would like to see the graphs if possible. Please upload. You can use the site's uploader to post the scanned graphs. Alternatively you could mail them to my attention (ATTN: Dr. Gopal Krishna Dash) and post it attachments@healthcaremagic.

If you cannot, the presence of few sharp waves may suggest that you have a chance of relapse in stressful situations. However, you need not restart the medications.

Best wishes

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Gopal Krishna Dash (1 hour later)

Thanks Doctor,

I have upload the pictures of EEG GRAPH,

I am little confused over your advice 'NEED NOT RESTART THE MEDICATION'

Weather I have to restart medicine or continue wittout AED.

Answered by Dr. Gopal Krishna Dash (2 hours later)

Hello,

Thanks for the query

I have seen the graphs

You stay relaxed and continue without AED

Best wishes

Above answer was peer-reviewed by : Dr. Mohammed Kappan

Follow up: Dr. Gopal Krishna Dash (1 hour later)

Thanks a lot Doctor for your kind suggestion.

Just one more thing pleas confirn what kind of thease waves observd in my EEG.

Here Doctor said it is kind of focal mirror waves in right part of brain but not to worry it is due to calcify in left and advice Encorate 300 mg one Tablet once in a week.

But I am not going to take as per your advice, and also I think there is no benfit in taking one tablet in a week.

What you suggest Sir.

Answered by Dr. Gopal Krishna Dash (8 hours later)

Dear Sir,

The decision to withdraw medications in patients with epilepsy depends upon the factors that i have already discussed in my first response to you. The graph that you have provided (poor images and only few pages and hence limited) did not show any definite epileptiform discharges. With due respect to your physician i feel that you should not take once a week Encorate. I feel that you should not be on any medicine/AED now. If seizures relapses (very rare chance), we shall deal accordingly.

Just do not worry and relax

Best wishes

Dr Gopal K Dash
Consultant Neurologist and Epileptologist XXXXXXX Hrudayalaya Hospital, Bangalore

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Gopal Krishna Dash (6 hours later)

Dear Doctor,

For clear vision of graphs I have mail them to on YYYY@YYYY and mention in subject (ATTN: Dr. XXXXXXX XXXXXXX Dash).

Also upload clear pictures.

Please check mail and revert,

Thanks ,
XXXXXXX

Answered by Dr. Gopal Krishna Dash (7 hours later)

Hello sir,

Thanks for sending those graphs to me

There are no definite epileptiform discharges in the graphs that you have sent in my mail.

As far as my opinion is concerned, you don't need to be on any antiepileptic drugs.

Please close this discussion if all your queries are answered.

Best wishes

Above answer was peer-reviewed by : Dr. Prasad