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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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What causes focal seizures despite being on medication?

Dear Sir/Madam, My daughter Ananya has been diagnosed with Simple Focal Seizures. I want help in this regard Her Date of Birth is 15th Mar 2013, Age: 4.5 Years, Weight: 15.5 Kilograms FIRST ATTACK: The first attack happened on 27.07.17 morning @ 5:30 am, my daughter 4.5 year old suddenly started crying in sleep and was yelling that something was happening to her leg, when I checked immediately, her left leg was shaking. Immediately I massaged her leg and make her stand but she was not able to stand and her legs were loose and she was not able to control her leg movements. Later I make her sit on stool and massaged her leg after that she was ok and was playing actively as usual. Later seeing her active I went to office at 7:40am on that day. This episode lasted 1.5 minutes & she was conscious during this period. When I was in office my wife called me at 8:15am again said her leg was again paining & jerking, her left leg became hard and she fell down shaking her left leg and body. She has massaged her leg and within 1 – 1.5 minute she was again normal playing as usual. I came and took her to local pediatrician who has said that it may be due to calcium deficiency and prescribed calcium syrup. Again after coming back from doctor while she was playing again her left leg muscles became stiff and again her left leg was shaking at 11:30 am. Again the same has repeated at 3:00 PM. We have rushed to our regular family pediatrician on that day at by 6:00 PM and at 6:15 PM at his table the same has repeated. On seeing her doctor has said that she is having Simple Focal Seizures and she was admitted to the Hospital HOSPITALIZATION: Immediately we rushed her to Hospital by 27.07.17 evening 8 PM, she was kept on Anti-convulsion IV Fluids and a series of tests have been done on her. Next day all test results were reviewed by Pediatric Neurologist and she said that all other reports were normal but need to start LEVIPIL Syrup (Composition: Levetiracetam -100mg/ml) as she got that many attacks on one single day, They have suggested to use 2ml Levipil twice per day with Multi Vitamin Syrups and was discharged. (I have attached Test Reports during Hospitalization) Next Attack: Later after discharge since she was absolutely OK, I have not started Levipil and have given Multi Vitamins only. On 31.07.17 at 9:43 AM again she got the attack similarly her left leg muscles became stiff and her left leg was shaking, she was totally conscious and was responding to all the commands given by us. Immediately we have called our Pediatric Neurologist and she asked us to start 2 ml Levipil immediately. Later after starting the same the Seizure attacks were stopped. On 09.09.17 (40 Days After starting the medicine) Again on this day 09.09.17 at 5:30 PM similar attack has happened, Her left leg became stiff and was shaking. She was conscious during this period. What has happened on this day was, I forgot to give medicine on morning. The dose was delayed by 3 Hrs in the morning. Upon consulting our Pediatric Neurologist, she suggested not to miss the dose and we will increase the dose if it seizure repeats only. Later we have made sure that she gets the medicine correctly and later the seizures had stopped. So we were continuing the same dose of 2ml Levipil twice per day and maintained timings strictly On 26.10.17 (46 Days after Previous Attack) Despite adhering to strict timing in medicine dose on 26th Oct ’17 at 5:00 PM, she has got similar attack immediately when she came back from school. Her left leg became stiff and was shaking, she was conscious during this period and responding to all commands given by us. Upon consulting our Pediatric Neurologist, she suggested to increase Levipil Dose from 2 ml to 3 ml twice per day. Since she was going through exams in the school, I thought that this was due to stress of exams and I have increased the dose from 2ml to 2.5 ml twice per day, and later she was OK. Her body weight on this day was 16.1 Kg On 29.10.17 (Within 3 Days after Previous Attack) Despite after increasing the Levipil dose from 2ml to 2.5ml Twice per day on 29th Oct’17 at 3:20 PM, she has got again similar attack. As suggested by our Pediatric Neurologist, I have increased the dose again from 2.5 ml to 3ml Twice per day and started observing her. On 31.10.17 at 7:20 AM (Within 1.5 Days after Previous Attack) Despite increasing the dosage to 3ml she has again got the similar attack on 31.10.17 at 7:20 AM but this time the duration was less compared to 1 to 1.5 Minute previously it was now nearly 40 Secs. Upon consulting our Pediatric Neurologist, she suggested to continue 3 ml twice per day, till next 5 days as it will take some time to settle and we will wait for the dose to work, and she said that if the dosage is not working we will increase to 3.5ml twice per day. On 31.10.17 at 7:40 PM (Within 12 Hrs after Previous Attack) Again similar attack came in the evening at 7:40 PM with same 30-40 Sec duration, as suggested we have continued 3 ml twice per day dosage On 01.11.17 at 8:30 AM (Within 13 Hrs after Previous Attack) Again similar attack came in the morning at 8:30 AM with same 30-40 Sec duration, as suggested we are continuing 3 ml twice per day dosage On 01.11.17 Evening, I have increased the dosage of Levipil from 3ml to 3.5ml Twice per day On 03.11.17 Morning at 8:45 AM again she has got similar attack As per Doctor advice, not increased the dose further and kept at 3.5 ml only From last one week (26.10.17) she has got 5 attacks and the duration between attacks is gradually reducing, I am very much worried on the condition of my daughter, please guide me what to do. Also I have few questions on my mind. 1.     Why is she getting attacks again from last one week despite correct medical dose 2.     Is there any diet related issue to this, I have made few inclusions in the diet of my daughter from last one month apart from regular diet a.     Added habit of eating nuts in her daily diet at evening after coming from school – 5 Nos Cashew Nuts, 5 Nos Hazel Nut, 5 Nos Pista, 2 Nos Dried Cranberry & 5 Nos Almond b.     Daily one boiled egg c.     Changed from Low fat milk to High Fat Milk d.     Started using Pediasure Powder with milk e.     Weekly Twice Lamb curry (Mutton) with Liver 3.     What is the long term from here, will she be coming out from this with use of medicines, our doctor has said that long term treatment is required and we have to use medicines may be for 1 or 2 years timeline 4.     Apart from seizure attacks, she is totally normal in her behavior & activities and is actively playful. Not able to understand why so many attacks are happening? 5.     Is there any other alternate treatment for this in Homeopathy or Ayurveda for this condition 6.     I have seen online sites that reducing Carbohydrates will reduce the tendency for seizures, how far this is correct Seizures Episodes Summary Till Now: 27.07.17 5:30 am, 8:30 am, 11:30 am, 3:00 pm, 6:15 pm [5 Attacks on this day] Hospitalized on 27th July 8pm 31.07.17 9:43 AM Levipil started from 31st July 17 09.09.17 (40 Days After starting the medicine) 6:45 pm Morning Medicine delayed by 3 Hrs on this day 9th Sept 26.10.17 (46 Days after Previous Attack) 5:00 pm Suspected Exam stress Increased Levipil Dosage from 2ml to 2.5 ml 29.10.17 (Within 3 Days after Previous Attack) 3:20 pm Increased Levipil Dosage from 2.5ml to 3ml 31.10.17 (Within 1.5 Days after Previous Attack) 7:20 AM, Continuing same dose 31.10.17 (Within 12 Hrs after Previous Attack) 7: 40 PM, Continuing same dose 01.11.17 (Within 13 Hrs after Previous Attack) 8:30 AM, Continuing same dose On 01.11.17 evening, increased dosage from 3ml twice to 3.5ml Twice Again on 03.11.17 again she got similar attack at 8:40 AM
Tue, 17 Jul 2018
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Pediatrician 's  Response
Hello. Welcome to 'Ask A Doctor'. I have read your query and here is my advice.
To begin with, I think you are a highly intelligent person. You have presented the most complete accounting of your child's history than any other parent I have seen since starting work with 'Ask A Doctor.' This is a great aid to me. Thank you.
The anti-seizure medication your daughter's neurologist(I hope this doctor is a pediatric neurologist) is one that is often given to pediatric patients. To be effective in controlling seizures, anti-seizure medicines must obtain a certain level in the blood. (Levels are different for each medicine.) When a new seizure medicine is begun, it usually takes several doses to reach this level in the patient's blood. If a medicine is taken once or twice a day, then it will take a few days to reach this level.
Sometimes doctors draw blood from their patient and send it to the lab to determine the blood level.
Causes of seizures despite taking anti-seizure medicine:
-not giving medicine as prescribed
-missing doses
-patient gaining weight
-lack of adequate sleep(A five year old child ought to have 11-12 hours of sleep in 24 hours.)
-taking other drugs that interfere with the seizure medicine
-there are patients who require more than one medicine to control seizures
May your daughter do well.
Hope I have answered your query. If you have any further questions, I will be happy to help.
Arnold Zedd, MD, FAAP


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