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Taking treatment for epilepsy & paranoid schizophrenia. Prescribed with Chlorpromazine, Oxetol and Eptoin. What can be done further?
Question: Respected Doctor, My son who is aged 30 yrs, unmarried, is under treatment for epilepsy & paranoid schizophrenia. We noticed some unusual behaviour when he was in 9th standard (15 yrs old). Year 1997 - Smiling and talking to self frequently was noticed and we took him to a psychiatrist who after examining my son asked us to stop his schooling and also told that my son is having mild mental retardation. This aspect of my son having mild mental retardation went unnoticed since there was no advanced medical facilities available in our town. The Doctor prescribed risperidone 1mg od for a month. Since the odd behaviour did not subside, the dose was increased gradually up to 16mg per day. This led to mild hand jerks for which Tab. Pacitane 2mg od was added to the existing medicine. This to some extent controlled his jerks. During 2001 he had his first epileptic attack. He was put on Tab Oxetol and Eptoin and till date total 4 epileptic attack had taken place. Three episodes of epileptic attack at different intervals was due to withdrawal of Tab Oxetol and Tab Eptoin for some other reasons. Presently he is in a rehabilitation centre and is on the following drugs : 1. T. Chlorpromazine 200mg 1-1-2 2. T. Oxetol 300mg 1-0-1 3. T. Eptoin 100mg 1-0-2 4. T. Zypsydon 80mg 1-0-1 Apart from the above drugs, during his stay at the rehabilitation centre he was tried on Sulpitac, Serenace, Sizopin,Ilosure, Quitipin, Asenapt, (all in maximum recommended dosage), except, clozapine but showed only partial improvement. The present condition is that talking to self and pacing behaviour still persists. Shall be grateful, if you could suggest what next is required to be done? Thanks and regards, XXXXXX
Brief Answer: Explained below. Detailed Answer: Hello Mr XXXXXXX Welcome to Healthcare Magic! If your son was well till the 9th standard and managed to pass his exams and get promoted till he reached the ninth standard, it is unlikely that he has mental retardation. The problems that he had in the ninth standard appear to be symptoms of schizophrenia only. Regarding his seizures, he may have epilepsy or the seizures may have been the adverse effects of the antipsychotic medications, most of which reduce the seizure threshold. He is currently on two medicines to control his seizures, oxcarbazepine and phenytoin. Of the two, phenytoin is a bad choice as it intereferes with the metabolism of other medicines and lowers their levels in the body and thus, their efficacy too. I would have preferred to put your son on only one anti-epileptic, valproate. It is effective and does not interfere much with other medicines. Regarding the antipsychotics, it appears he has been tried on many but I do not see the name of olanzapine. It is quite effective and perhaps it too was tried at some point of time. If all options have been exhausted, the one that must be given a fair trial is clozapine (Sizopin). You mention that it helped your son but have not said why it was stopped. There is a higher risk of seizures with clozapine but that would not be a problem as your son is being treated with anti-epileptics. Clozapine gives good results even in patients who have not responded to other medicines. There are some adverse effects but these can be managed. In my opinion, your son should be treated with only two medicines, clozapine and valproate. I hope this clears up things for you to some extent. Please let me know if you need any clarifications. Best wishes. Dr Preeti Parakh MD Psychiatry
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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