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Dr. Andrew Rynne

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Suggest treatment for recurring fits in a child

Answered by
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Dr. Neeraj Kumar

Neurologist

Practicing since :2006

Answered : 2263 Questions

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Posted on Mon, 2 Nov 2015 in Headache and Migraines
Question: Since 2005, my younger sister has been suffering with fits/stroke. in 2005, the fits was 2- 4 min. Her whole body got rigid/tight. We started the treatment from Dr. R.C. XXXXXXX He started 'Desval'. For 2.5 years. There was no issue as such. We made a mistake and stopped the medicine on our own. After stopping the mdicine. she suffered the fits in next 2.5 months. We again visited him and Dr. started the drug 'Lamitor DT 100 mg'. Patient faced the fits in next one year again while medicine was continue. Dr. increased the dose of 'Lamitor DT '. Patient again faced the issue in next one year. We moved to Dr. K.B. Hasti in XXXXXXX He started the tablet 'Lamitor DT' along with 'Levispy'. Patient faced the fits in next one year again. Dr. Hasti increased the dose of 'Lamitor' and 'Levispy'. Patient again faced the fits in next one year. Now in the last three months she has faced thh same issue several times. Right she is on 'Lamitor DT 100 mg', 'Levispy XR 500 mg' and 'Lacoset 100 mg'. Need your guidance.
doctor
Answered by Dr. Neeraj Kumar 1 hour later
Brief Answer:
Change drugs and consult some institute

Detailed Answer:
Hello dear,
I have gone through your question and reports and understand your concerns.
Uncontrolled seizures may be due to inappropriate drug , dosage, medication gaps/default, resistant epilepsy.
Seizures in females with onset in adolescence should be evaluated for JME(juvenile myoclonic epilpesy).
Is there any history of myoclonic jerks , absence seizures or generalised tonic clonic seizures in morning on awakening in a sleep deprived state.
You can get video EEG recording and MRI epilepsy protocol.
IS there any family history?
For treatment follow rules like adequate night sleep (8 hours) and timely drug intake.
Valproate (Desval) should be tried again if it was controlling seizures well initially.
Consult a neurology center like KGMU, XXXXXXX SGPGI ,PGI XXXXXXX in north XXXXXXX or NIMHANS, CMC vellore in south XXXXXXX
Possibility of pseudoseizures should also be evaluated and it requires video recording of actual episode.
Hope you found the answer helpful.
Do get back for further queries
Regards
Dr Neeraj Kumar
Neurologist
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Neeraj Kumar 9 days later
Dear Doctor,

Thank you so much for your kind suggestion.

There is no history of such stroke/epilepsy/fits in our family. Before this issue, she had never faced any kind of myoclonic jerk, absence seizures etc. However, over these years, the days she faced fits, on those mornings she complained heavy headache and sleepy condition generally. Other days she used to be absolutely fine. Her BP remains nearby 100/60 with weight 50 kg.

Her sleeping time is 9:30 pm – 6:30 AM every day. Whole family take care of her medicines. We have consulted several institutes i.e. XXXXXXX XXXXXXX XXXXXXX Forties XXXXXXX Medanta XXXXXXX Apollo XXXXXXX and some retired XXXXXXX neurologists as well. Everyone is prescribing some different treatments. All those are mentioned below.

1)     Lamitor DT 100 mg (mor & eve) + Levepsy 750 mg (mor & eve)
2)     Lamitor DT 100 mg (mor & eve) + Levepsy 750 mg (mor & eve) +Frisium 10 mg ( eve)
3)     Levipil 750 mg (mor & eve) + Frisium 10 mg ( eve)
4)     Lamitor 100 mg (mor & eve) + Levepsy XR 750 mg (mor & eve) +Frisium 10 mg ( eve) + Valparin 500 mg (mor & eve)
5)      Our present Doctor is suggesting - Lamitor DT 100 mg (mor & eve) + Levepsy XR 500 mg (mor, noon & eve) +Cloba 10 mg (mor & eve) + Disadix 500 mg (mor +eve)

We have following questions.
1)     Some doctors are suggesting Lamitor and Desval are good drugs, need to start it. Some doctors are saying Lamitor and Desval are good drugs, but not good for Female at this age. We are confused who are right?
2)     She was already on Lamitor DT 100 mg & Levepsy 500 mg for around 3 years, but still facing fits (earlier once in year, but in past two months around 4-5 times),then why some Doctors want to repeat the same drugs?
3)     Right now the kind of fits, she has been facing for last two months - her whole body gets tight/rigid, her hands start jerking, she faces problem while breathing, teeth/jaws tightly closed, eyes rolling up and sometimes she starts crying. This goes up to 45 mins nearby. Right now, She doesn’t lose her consciousness in this situation. She knows what happening to her, she knows that she is crying, her teeth are tightly closed and eyes have rolled up but she can’t control it that time. She doesn’t urine and no foam come out from mouth. After the fits, she feels sleepy whole day after that she feels and behave normally. Video of her recent fits is attached herewith. Based on that, kindly suggest what treatment we should start?

Seeking your expert guidance so that she can get relief and live a normal life.
doctor
Answered by Dr. Neeraj Kumar 1 hour later
Brief Answer:
Change the drugs or wait for some time with the current medication

Detailed Answer:
Hello Dear,
Treatment in epilepsy is difficult in some cases. In uncontrolled cases , the drugs are tried one by one and often in combinations.
There are many drugs available which are prescribed according to disease, age , sex and tolerance.
All drugs have some or other side effects and thus be given in some dosage.
Valproate is a good drug but in female carries risk of weight gain and polycystic ovarian syndrome.
Levetiracetam is having side effects of decreased concentration, agitation and memory impairment in young.
I will advise you to get MRI epilepsy protocol.
The treatment can be switched to
1) valparin chrono 500 mg bd
2) lacoset(lacosamide) 25 mg bd to be increased weekly by 25 mg upto 100 mg bd
3) Frisium 10 mg in night
Video is not available for review . consult the help desk of health care magic.
In uncontrolled cases, surgery is an option if a focus is found.
Hope you found the answer helpful.
Regards
Dr Neeraj
Neurologist
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Neeraj Kumar 4 hours later
Dear Doctor,

Thank you so much for your prompt response.

You suggested to remove Lamitor and Levespy from the treatment. That means these drugs are not good for my sister right now?

Is there any difference between Valparin and Valparin chromo bd?

All doctors, here, are saying Lacoset is one of the best drugs, but not good in such kind of seizures so stop it now. It is increasing the problem right now instead of providing relief. As far as I remember they said it's partial epilepsy.(I think so). Kindly suggest.

FYR, I have attached the latest prescription our Doctor too.


doctor
Answered by Dr. Neeraj Kumar 46 minutes later
Brief Answer:
Get brain neuroimaging as advised and switch to valproate under guidance

Detailed Answer:
Hello dear,
Levepsy and lamitor are also good drugs but the reason i am advocating valproate is initial effectiveness of this drug.
The reason for advocating MRI epilepsy protocol is to look for any temporal lobe epilepsy best detected on such imaging. Also EEG report or images is required for decision regarding generalised or focal onset seizures.
Lacosamide is helpful and approved for focal onset seizures while valproate covers all type of seizures.
Since lamitor has been used for long without any benefit. It can be stopped.
Valproate with levepsy or lacosamide may be tried with frisium.

Not much difference between valparin and valparin chrono . valparin chrono is having once daily dosage also with longer t1/2 time.
In few cases the control m,ay not be complete even after2or 3 drugs in adequate dosage.
Hope you found the answer helpful.
Dr Neeraj Kumar
Neurologist

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