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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest Treatment For Right Sided Mesial Temporal Sclerosis

My daughter presently 14 yrs 5 months old, 48 kg weight, had her first convulsion during Oct-2009 at bed time for about 12-15 mins. She was given Zeptol CR (200mg) 2 tabs daily but developed body rash as well as very high fever and hence medicine was stopped. She was OK but suffered a second similar convulsion on 7th March, 2010 (Weight-36 kg) early morning for about 10 mins. She was advised to take 1 tab Valparine chrono 500 mg in the night daily. She was OK till Oct-2011 (i.e. 18 months). On 11th Oct, 2011 early morning she had suffered similar convulsion thrice between morning 5am to 8.30 am followed by vometting and head pain.She was admitted in hospital for observation and on release after 4 days was advised tab levipil 500 mg 2 tabs daily, and clobazam-10 mg 1 tab at night, 1 tab Folvite. She is getting hyper, and occasionally having leg pain and low mood. I had subsequently consulted a 2nd neurologist at Kolkata who suggested the following medicines- i tab Dicorate ER 750 mg after Break fast, 2 tabs Levipil 500mg as above, 2 tabs Lacoset 50 mg, 3 tabs Synaptol 50 mg, 1 tab Becosule Z - all on daily basis. In this connection I would like to state that since June/ July 2011, she used to complain about a problem which leads to occasional jumbling up of noises in her ears for few sec/ a minute during which she cannot speak or see clearly and often sees a flash/ ring of light moving across her eyes. She had undergone MRI which states- "Imaging features suggests the possibility of right sided mesial temporal sclerosis. Clinical co-orelation advised."
Her EEG report dated 7.10.2009 stated- Interictal state of seizure disorder.
Her EEG report dated 07.03.2010 stated- Abnormal awake EEG showing intermittent generalised slow waves reflecting Epileptiform activity. Her current EEG report dated 14.10.2011 stated - Normal awake EEG tracing.
I would request you to kindly advice me about the disease and prescribed medicines to follow as above and reasons for recurrance and recovery process.
In this regard I would like to inform you that she was bit stressed for her exams and will appear for 10th class final exams in next Feb-2012. However her selection tests are due around mid Nov-2011. She is now complaining of often forgetting studies/ leg pain after walking for a while.
I can also send you the relevant reports etc if you would kindly revert back to me.

Regards,
A.Basu Thakur
1/30 Naktala, Kolkata- 700047
0000.
Mon, 6 Oct 2014
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Neurologist 's  Response
Regarding the title asking for treatment of mesial temporal sclerosis there are two options, either medical therapy with anti-epileptics or surgery. However as the MRI report suggests, surgery is considered only when it is sure from the type of seizure and EEG reports that seizures are generated in that region. From what you say neither the type of seizure corresponds to the typical seizures of that region (no clinical correlation), nor does the EEG report focal abnormalities belonging to that region. Even if that was the case surgery is usually reserved to cases with frequent seizures resistant to treatment. So I'd not consider surgery.
Regarding the present treatment she seems to take 3 anti-epileptics (Dicorate, levipil and lacoset). While they're widely used drugs they have also their side effects (like the complaints you mention in the last paragraph) and I usually reserve triple therapy only to the most resistant cases because of that.
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Suggest Treatment For Right Sided Mesial Temporal Sclerosis

Regarding the title asking for treatment of mesial temporal sclerosis there are two options, either medical therapy with anti-epileptics or surgery. However as the MRI report suggests, surgery is considered only when it is sure from the type of seizure and EEG reports that seizures are generated in that region. From what you say neither the type of seizure corresponds to the typical seizures of that region (no clinical correlation), nor does the EEG report focal abnormalities belonging to that region. Even if that was the case surgery is usually reserved to cases with frequent seizures resistant to treatment. So I d not consider surgery. Regarding the present treatment she seems to take 3 anti-epileptics (Dicorate, levipil and lacoset). While they re widely used drugs they have also their side effects (like the complaints you mention in the last paragraph) and I usually reserve triple therapy only to the most resistant cases because of that.