Suggest treatment for refractory epilepsy
Hi XXXXXXX thanks for asking from HCM.
I can understand your concern. Your father is suffering from refractory epilepsy. I need more information about his disease
- What anti epileptic drugs, is he taking?
- What is the report of EEG and MRI brain ?
- Is he totally complaint with medication or irregular intake?
In case of refractory epilepsy, the doctors first increase the dose of medication till maximum safe dose. If still no relief, he/she will add more medication and increase the dose. Usually 4 medications at maximum dose can be given. Upto 90% patients respond. In rest 10% cases, epilepsy surgery can be considered as one option.
Epilepsy surgery is decided based on
- MRI brain findings
- EEG findings
- 24 hour video EEG findings.
The results of epilepsy surgery are good if
- Focal epilepsy
- Well defined lesion in brain
Please provide me answers of above questions. I will guide you further.
Hope it will help.
Hi XXXXXXX welcome back.
Your father is taking four antiepileptic drugs
- Levetiracetam (Levipil) - maximum dose
- Lacosamide (Lacoset) - maximum dose
- Divalproate (Dicorate) - medium dose
- Phenobarbital (Gardenal) - medium dose
If still he is having seizures, then he must undergo fresh MRI brain and EEG to know the focus and epileptic current discharge area. Depending upon the report, he might be considered for epilepsy surgery.
If unfit for surgery, then the dose of Dicorate can be increased to 500mg (M), 250mg (afternoon) and 500mg (E). Serum level of each drug is needed to know if the drug concentration is adequate in blood or not.
Hope it will help. If still having doubts, do let me know.
Thanks. Take care
Having Sugar and BP issues No one is suggesting for surgery.
Can you please suggest a nuerologist in XXXXXXX
Thanks a lot for the appreciation
Hi XXXXXXX welcome back.
I got your point. He is old age, having sugar and BP. Surgery in such case carries higher risk than normal. So continue with medication.
In XXXXXXX you should consult either Dr XXXXXXX XXXXXXX at KIMS. She runs epilepsy clinic and also select patients for epilepsy surgery. I have met her once during epilepsy workshop. I really liked her thorough knowledge about epilepsy.
I hope you will get best advise for your father.
Thanks. Take care.
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