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Suggest Treatment For Clonic Seizure

Posted on Tue, 18 Mar 2014

Question: I have tonic clonic seizures that started 6 years ago after I donated plasma. My siezure have since been uncontrolled and all the EEG's and MRI's have been normal. I have gotten discouraged and about a year ago I gave up on medical treatment because no one could figure anything out. One neurologist suggested that they were pseudoseizures so I saw a therapist and there was no change. Well a couple of months ago they flaired up again so I saw a neurologist and he thinks they are epileptic seizures because of my aura (metalic taste in my moth, dizzy feeling and ringing in my ears)as well as the seizures them selves so he had me do an MRI which was normal and I am currently doing a VEEG. So my question is this, if my VEEG is normal like they have been in the past, what will likely be the next step? My seizure are extremely uncontrolled and I just want some releief. I am tired of my condition ruling my life and I just want some answers.

Answered by Dr. Sudhir Kumar (48 minutes later)

Brief Answer: Your symptoms are suggestive of seizures. Detailed Answer: Hi, Thank you for posting your query. I have noted your symptoms and the fact that your MRI brain and EEG have been normal. I can also understand your frustration with lack of a clear cut diagnosis and normal investigation reports. I would like to point out here that MRI and EEG may come normal in about half the patients with epilepsy. I agree with your current neurologist that your symptoms are suggestive of complex partial seizures. If you have not done MRI in a 3.0 Tesla MRI machine, it may be worthwhile doing the same, as there are greater chances of picking up abnormalities in 3.0 Tesla as compared to 1.5 Tesla MRI machine. if your video EEG is normal, then, you could also consider doing a PET scan of brain. I feel you should be started on anti epileptic medications such as oxcarbazepine. I hope it helps. Please get back if you have any more queries. Best wishes, Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (16 minutes later)

The most recent MRI that was conducted was done so using some kind of frequency that is used especially for seizures. I am not sure what that means but I can upload some of the images that the center put on CD for me. Also, I would like to point out that I have been on anti epileptic medication such as keppra, dilantin, trileptal, lamictal, vimpat, trokendi, and I am currently taking topirimate. None of these medications have seemed to help in decreasing the number of seizures that I am having. I have been on more than one medication at a time as well. You have mentioned that I should consider doing a PET scan. Can I ask what that would show? In the event that that is normal as well (since with my luck all the tests seem to turn out normal) what my options would be then? Have you had any cases like mine that you were able to diagnose the kind of epilepsy they had with a PET scan or with any other tests after that? Is there anything else that I may be able to suggest to my neurologist so that I may be able to get answers sooner rather than later? Sorry for all the questions, but please understand I have been battling the unknown for 6 years and it seems like I am no closer to finding anything out than I was when I had my first seizure.

Answered by Dr. Sudhir Kumar (6 hours later)

Brief Answer: Your current MRI is 1.5 Tesla. Detailed Answer: Thank you for getting back. I have seen the images of MRI sent by you. It is 1.5 Tesla and not 3.0 Tesla. On the MRI images, on top left, you can see 1.5 T mentioned. It would be useful to undergo 3.0 Tesla MRI and get it reported by a neuroradiologist trained in looking at epilepsy MRIs (specially medical temporal sclerosis and focal cortical dysplasia). These findings are subtle and get missed on routine scans and by "less trained eyes". I agree you have been tried on various medications. However, you deserve a rational polytherapy (combination of anti-epileptic drugs), based on the source of epilepsy (as per MRI, VEEG, PET, clinical symptoms, etc). Yes, there are chances of picking up abnormalities of PET (positron emission tomography) even if MRI and VEEG are normal. I have seen several such cases. PET is a functional imaging tool (as against MRI, which is structural imaging). I hope this helps. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar