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What Do My Scan Reports Indicate?

Posted on Thu, 25 Aug 2016

Question: Hi Doctor,
I am Sunipa Banerjee from West Bengal.I consulted with you at Apollo Hospital, XXXXXXX on 05/07/16.PET-CT done on that day as per your advice.
Impression found-
SCAN LOCALISES MODERATE HYPO METABOLISM IN RIGHT MESIAL TEMPORARAL REGION.
MILD HYPO METABOLISM IN BILATERAL THALAMI - FOR CLINICAL CORRELATION.
After taking LACOSAM (100-0-100), some symptom occurring which is unbearable.Would I continue the medicine with the same dose as you prescribed?
Your suggestion please.
Symptom is given hereunder.

Answered by Dr. Sudhir Kumar (8 hours later)

Brief Answer:
Continue 100 mg Lacosam daily

Detailed Answer:
Thank you for getting back.

I have noted your symptoms.

At this stage, please continue LACOSAM 100 mg once daily at night for one month. Let me know your condition after one month. Then, we would decide the dose of LACOSAM, whether to increase or not.

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 (23 hours later)

Dear Doctor,
I have started Tab Lacosam 100 mg/day from today as you prescribe.Can you prescribe me any medicine to relief the electrical spark like sensation and pain in the right upper portion of the head, which is unbearable and still persisting.

Regads,
Sunipa Banerjee

Answered by Dr. Sudhir Kumar (21 minutes later)

Brief Answer:
Please continue the current medications

Detailed Answer:
Thank you for getting back.

As of now, please continue the current medications for a month. This is because using too many medicines may cause adverse effects.

Best wishes,

Dr Sudhir Kumar MD DM (Neurology)

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

Follow up: Dr. Sudhir Kumar (39 hours later)

Dear Doctor,
Now my wife Sunipa Banerjee,is taking the medicine as per your prescription(Tab LACOSAM 100 mg/day with other medicine).
Now the symptom are-
1.Last two days seizer episode - 3 times
2.sometimes she is laughing/crying
3. Sometimes she is going in a confused state.
4. Aggressive/agitative
5.very weak- she can not move inside the house without support.
other symptom which she wrote to you earlier is also persisting.
your advice please.

with regards,
Pradip banerjee
H/o, Sunipa banerjee

Answered by Dr. Sudhir Kumar (5 hours later)

Brief Answer:
Let the new medicine continue for a month

Detailed Answer:
Thank you for getting back.

The effect of new medicine would be fully known after using it for at least one month. Please maintain a seizure diary and record the number of seizures during this period of one month.

After that, we would review regarding any changes.

Best wishes,

Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Priyanka G Raj

Follow up: Dr. Sudhir Kumar (2 days later)

Dear Doctor,
My wife hospitalised today morning due to vomiting and could not see anything. The other problem which are told to you earlier also still persisting.The local doctor advice me to stop Tab LACOSAM and increases the dose of tegrital 200mg and frisium 5 mg.

Sir, I need your advice urgently as she can not tolerate this medicine.
Sir, Please.

With regards.
Pradip Banerjee
H/o, Sunipa Banerjee

Answered by Dr. Sudhir Kumar (38 minutes later)

Brief Answer:
I agree with the advice of local doctor.

Detailed Answer:
Thank you for getting back.

I have noted the current symptoms. I agree with the advice of local doctor regarding the increase in dose of tegrital and frisium. Please follow the advice.

Best wishes,

Dr Sudhir Kumar MD DM (Neurology)

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

Follow up: Dr. Sudhir Kumar (5 days later)

Respected Doctor,
As per your consent I have stopped Tab Lacosam and increase the dose of Tab Tegrital CR by 200mg and Tab Frisium by 5mg from 29/7/16.Therefore, my wife is now taking 1600 mg Tegtrital and 15 mg frisium/day.

The side effects which are started after start taking of Tab LACOSAM are still persisting.

1.     Seizure episode-2-3 times/day ( previous 4-5 times/2 months)
•     Therefore, Frequency of seizure episode increases
2.     Nausea, headache, blurred vision, weakness
•     Which are nothing before using Tab Lacosam

Therefore I am waiting for your advice to relief from the above.

With regards,
Pradip Banerjee
H/o, Sunipa Banerjee

Answered by Dr. Sudhir Kumar (40 minutes later)

Brief Answer:
Medicine change should be done after one month

Detailed Answer:
Thank you for getting back.

I have noted the current symptoms.

Any further increase in dose of current medicines or addition of new medicine should be done after a gap of at least one month. So, maintain a seizure diary documenting the number of seizures in one month period.

Regarding side effects due to lacosam, you have already stopped it. No further action is needed. The side effects would vanish over time.

Best wishes,

Dr Sudhir Kumar MD DM (Neurology)

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