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Suggest Treatment For Frequent Seizures
Question: My daughter is 19 months old. A few weeks ago she started having these episodes that I found are seizures. She started off with having 1 or 2 a day or every few days. Increasing to 4 per day. Took her to hospital found out she's having partial seizures possibly due to a heterotopia on right side. EEG for 24 hrs. Started with keppra (generic brand) still having seizures and increased to 15 per day. Increased dosage to 4.5ml. Added Trileptal slowly. Now at dosage of 3.5 ml. Seizures slowed down to maybe 6 a day. Since went up to 3.5ml seizures increased a little, at one point had 3 within 6 minutes. Been on Keppra 2 weeks and now on Trileptal one week. My question is does it appear that the medication is not working? If not, what could our possible next steps be? Different meds or surgery? Should this medicine be working by now? How long does it usually take for medicine to work? Is it an unusual case b/c of the amount of seizures she's having per day? Is there any hope for my baby?
Brief Answer:
We should give 2-3 months.
Detailed Answer:
Hi,
Thank you for posting your query.
I have noted your daughter's symptoms and her current medications.
I agree she has frequent seizures, and seem difficult to control. However, to label her seizures as medically-refractory, we should wait for about three months.
Also, the medicines need about a month to show the efficacy and it may take 2-3 months to achieve reasonable control of seizures. During this period, the dose of anti-epileptics may be increased gradually as per her body weight.
Long term video EEG recording may also help in further localization of seizures.
I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information.
Wishing you good health,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX XXXXXXX
Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar
My BLOG:XXXXXX
We should give 2-3 months.
Detailed Answer:
Hi,
Thank you for posting your query.
I have noted your daughter's symptoms and her current medications.
I agree she has frequent seizures, and seem difficult to control. However, to label her seizures as medically-refractory, we should wait for about three months.
Also, the medicines need about a month to show the efficacy and it may take 2-3 months to achieve reasonable control of seizures. During this period, the dose of anti-epileptics may be increased gradually as per her body weight.
Long term video EEG recording may also help in further localization of seizures.
I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information.
Wishing you good health,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX XXXXXXX
Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar
My BLOG:XXXXXX
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
little vague was looking for a more in depth answer
Brief Answer:
Possible steps are outlined below.
Detailed Answer:
Thank you for getting back.
I am sorry if I could not convey my message earlier. I will outline the steps here:
1. Wait for about one month, before changing any medication, as anti epileptic drugs take at least one month to show the efficacy.
2. New medications may be added after one month, if her current medications are not effective.
3. At least three months of medications (at least three different types) should be given, before we conclude that medicines have failed to control the seizures, also called as medically refractory epilepsy.
4. In a child with medically refractory epilepsy, surgery may be considered.
5. Prior to surgery, long term video EEG recording and PET scan of brain should be done to localise the site of epileptic origin.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Possible steps are outlined below.
Detailed Answer:
Thank you for getting back.
I am sorry if I could not convey my message earlier. I will outline the steps here:
1. Wait for about one month, before changing any medication, as anti epileptic drugs take at least one month to show the efficacy.
2. New medications may be added after one month, if her current medications are not effective.
3. At least three months of medications (at least three different types) should be given, before we conclude that medicines have failed to control the seizures, also called as medically refractory epilepsy.
4. In a child with medically refractory epilepsy, surgery may be considered.
5. Prior to surgery, long term video EEG recording and PET scan of brain should be done to localise the site of epileptic origin.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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