HomeAnswersNeurologycerebral palsyWhy do repeated seizures occur in a cerebral palsy patient?

How to control grand mal seizures in a cerebral palsy patient?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

Dr. Vinodhini J.

Published At March 13, 2020
Reviewed AtFebruary 6, 2023

Patient's Query

Hi doctor,

My sister has cerebral palsy with grand mal seizures. She is 28 years and weighs about 25 kg. Today she had a seizure attack about seven times that would last for almost a minute per attack. She underwent an EEG. Our neurologists are out of town, so we just needed an opinion on the following interventions we did.

In the morning, we gave her Lioresal 10 mg, Tegretol 200 mg, and Rivotril 2 mg. In the afternoon, we gave Diazepam Valium 0.5 mL. Whether we should add more for tonight? She still had two minor seizures for a few seconds. She was not able to sleep overnight last night until today.

Answered by Dr. Aida Abaz Quka

Hello,

Welcome to icliniq.com.

I thoroughly read your query and understand your concern.

I would suggest taking Tegretol 200 mg (Carbamazepine) three times daily and Clonazepam 2 mg two times daily. In case of repeated seizures, Diazepam should be administered 0.5 ml during each seizure. If seizures become frequent despite therapy, I would suggest bringing her to the ER (emergency room) because the situation may become life-threatening.

I hope this helps.

Thanks and regards.

Patient's Query

Hi doctor,

Thank you for the reply.

My second sister has recovered already. I would like to refer to another case. My other sister. She is 30 years old and weighs about 76 kg. She has had mild epilepsy (seizure disorder) since she was seven years old. She has eye twitching, hands raising, body shaking, tongue bite, and body spasms. Over the years, she has changed from liquid to tablet to mixed liquid and tablet forms of anti-anxiety and anti-epileptic medications. Her most current tablet is Depakote 500 mg taken twice a day. This was after coming from four tablets in the last four years, down to three and then to two. Her neurologist switched the tablet to Lamictal 200 mg twice a day. A few days after that switch, she had a major attack, and we performed all the necessary therapy, from oxygen to Dextrose. We eventually brought her to the hospital for Diazepam. She stayed for three days. After that incident, she went back to Depakote. Once again, she went back to her doctor and was recommended to switch to Lamictal another time.

Last month, however, she was about to have another attack, but we were able to notice the start of the mild seizure and automatically hooked her to our oxygen tank at home and had her Dextrose as well. She recovered later that day. It happened the following week as well. The same procedure was done. We wanted to have a second opinion on the change of her medication from Depakote 500 mg two times a day to Lamictal 200 mg two times a day. Please help.

Answered by Dr. Aida Abaz Quka

Hello,

Welcome back to icliniq.com.

I thoroughly read your query and understand your concern.

I agree with the switching to Lamictal (Lamotrigine), as this is a safer drug for young women compared to Depakote (Sodium valproate), which can lead to ovarian cysts and menstrual cycle irregularities in young women. Anyway, if seizures persist with Lamictal at this dose, I would suggest switching again to Depakote or Levetiracetam, which is another drug that can help dominate seizures. You should discuss with her doctor about the above issues.

I hope this helps.

Thanks and regards.

Patient's Query

Hi doctor,

Thank you for the reply.

I just wanted to get a second opinion regarding the change in dose for my sister with mild epilepsy. As you may possibly trace in my account, I have also inquired about her case before. Since she was seven years old, she has gone from liquid Depakote to tablet and to both liquid and tablet. Of course, all of these are based on her neurologist's recommendation and observation. Last month, her doctor recommended 100 mg of Lamictal, two tablets twice a day (400mg a day). This is from one year of three tablets per day. She had a seizure attack one month, and when they came back to the neurologist, she was then given this new dose. My mom is just wondering if this will have negative impacts on other organs in her body. Is there a possible effect on her behavior and attitude because of the medicines? We noticed she has become more irritable and impolite recently. Please help.

Answered by Dr. Aida Abaz Quka

Hello,

Welcome back to icliniq.com.

I understand your concern.

I would suggest that Lamotrigine is safer than Depakote, considering its adverse effects. Anyway, measuring Lamotrigine plasma levels every six months would help to make proper dose adjustments in order to take the right dose that is effective and not harmful. Regarding mood, you should know that both Depakote and Lamotrigine can help improve impulsivity and irritability. They are also usually used as mood stabilizers in aggressive or impulsive persons.

I hope this helps.

Kind regards.

Patient's Query

Hi doctor,

Thanks for the reply.

I am writing again because of my other sister with cerebral palsy (not the immediately previous case I asked but the other sister, the first case I asked about from you).

She has had cerebral palsy grand mal since birth. She is 28 years old and weighs 25 kg. Her current medications are Lioresal, Tegretol, and Rivotril, and past medications include Diazepam, Alprazolam, and an antihistamine.

For almost two weeks now, we have noticed that she has white sores in her mouth, like fungi. We brought the matter to a dermatologist, and she advised us to wash her mouth with a Dextrose solution. Fortunately, it has greatly diminished. We knew she was prone to this because we could not always brush her teeth and cleanse her mouth due to her condition. She also is being fed, always lying down position with blended foods. We noticed, however, that she has been choking even with water and also in the middle of the night with like a dry cough. She held her food before swallowing and even got to a point where she held food until choking. We administered that throat spray Difflam as we suspect she might have inflammation in her throat, which makes her choke and cough and causes her to hold food. When we sprayed Difflam, we noticed she was not holding her food anymore and was trying to swallow it already. She still chokes and, in the middle of the night, has a dry cough from choking randomly. Can we get your thoughts on this, as we are also afraid to bring her to the hospital, given the current situation? Thank you for taking the time to read this. Please help.

Answered by Dr. Aida Abaz Quka

Hello,

Welcome back to icliniq.com.

I read your question carefully and would explain that the difficulty in swallowing seems to be related to local throat inflammation, probably due to the fungal infection. For this reason, I would suggest using an antifungal gel, which she can swallow. In this regard, I would suggest using Daktarin (Micanazole) oral gel. If you can not find it, please show this name to the drug store or her doctor in order to find a similar gel that is available in your country.

Hope you will find this answer helpful.

If you have any other questions, please do not hesitate to ask me again.

Regards.

Patient's Query

Hi doctor,

Thanks for the reply.

I forgot to mention that my mom administered Daktarin also, but only externally, like around her lips and nose. Would it be alright to swab it in the roof of her mouth towards the reachable portion of her throat? Also, is it safe to use Difflam, the throat spray, for areas we cannot reach? Thanks for the useful insights.

Answered by Dr. Aida Abaz Quka

Hello again,

Welcome back to icliniq.com.

I understand your concern.

I would suggest using Daktarin inside the mouth three times a day at a size of a teaspoon. Let her hold it in her mouth and then swallow it. It is fine to swallow it for a week. If this is not effective, another treatment option would be taking Nystatin orally or 150 mg of Fluconazole. Regarding Difflam (Benzydamine hydrochloride), it is fine to take it in case of throat inflammation, but for no longer than a week. Its prolonged use is not suggested.

Hope you will find this answer helpful.

Let me know about everything in case you need further assistance.

Regards.

Patient's Query

Hi doctor,

Thanks for the reply.

I wanted to refer to you for continuity purposes from prior chats because I had referred my two sisters previously with similar cases. My first sister, aged 31, has mild epilepsy, and my second sister, aged 29, has cerebral palsy. This time, I am referring for consultation again for first my sister, who has had mild epilepsy (seizure disorder) since she was seven years old.

We asked for your second opinion sometime earlier this year because we have always noticed how she seems to be prone to attack with the current switch. You said you agree with the switching to Lamictal, as this is a safer drug for young women compared to Depakote, which can lead to ovarian cysts and menstrual cycle irregularities in young women. However, you also said that if seizures persist with Lamictal at this dose, you would recommend switching again to Depakote or Levetiracetam, which is another drug that can help dominate seizures. We wonder, with her current bouts of anxiety attacks and weight at 74 kg, would it be possible instead to increase the dosage of Lamictal, or would you rather have her change totally to Levetiracetam? If so, what would be the dosage and frequency, and would it matter if she takes her medicine before or after eating? Thank you very much for your patience and understanding.

Answered by Dr. Aida Abaz Quka

Hello,

Welcome back to icliniq.com.

I understand your concern and would suggest that Levetiracetam is a good drug for epilepsy, but it can worsen anxiety. For this reason, I would suggest trying adding Clonazepam to her current therapy and continuing both Clonazepam and Lamotrigine. Clonazepam can help against anxiety, and I think that it will help improve her situation. I would suggest taking Clonazepam 2 mg twice daily (starting at a low dose and increasing the dose slowly in order to avoid sedation). Another possible suggestion for treatment would be a combination of Depakote and Lamotrigine. It may be necessary to reduce the dose of Lamotrigine while adding Depakote because of the possible interaction between them.

I remain at your disposal for any further questions whenever you need them.

Kind regards.

Patient's Query

Hi doctor,

Thank you for the quick response.

Just a quick follow-up, is Clonazepam similar to Rivotril? Would it be alright to start with just 2 mg once daily before she sleeps? So the therapy would now be 6 AM 200 mg Lamotrigine followed by another 200 mg Lamotrigine at 6 PM and then finally the 2 mg Rivotril at around 8 PM shortly before she sleeps?

Answered by Dr. Aida Abaz Quka

Hi,

Welcome back to icliniq.com.

I understand your query.

Yes, Clonazepam is Rivotril. I would suggest starting with 1 mg at bedtime in order to avoid fatigue and sleepiness during the day, and increase the dose every three days by 1 mg, upto 2mg twice daily.

Hope you will find this answer helpful.

I would be glad to answer all of your questions at any time.

Regards.

Patient's Query

Hi doctor,

Thanks for the reply.

We will start her with Rivotril and will increase the dosage daily to 2 mg twice. Does she always take both at bedtime or one in the morning and one in the evening? Also, my sister is planning to have a baby. She was worried that all the years that she had been on medication and it could have impeded her pregnancy capacity. What would your recommendation be for a safe therapy that would allow her to bear a child?

Answered by Dr. Aida Abaz Quka

Hello,

Welcome back to icliniq.com.

I thoroughly read your query and understand your concern.

Regarding pregnancy, Clonotril (Clonazepam) may not be safe. Anyway, if started, it should be taken twice daily (every 12 hours), while Lamotrigine is really safe. There are no other safe drugs during pregnancy besides Lamotrigine and Levetiracetam, but Levetiracetam is not suggested because of her anxiety. All the drugs that she has taken during this long period of time do not have any influence on the future baby. Only the drugs that she will continue during pregnancy will have an impact on the baby. Anyway, seizures have really adverse effects on the baby as they cause hypoxia, which damages the baby. So, the decision is made based on the benefits and adverse effects of the anti-epilepsy drugs.

Hope you will find this information helpful.

Please let me know in case of further questions.

Regards.

Patient's Query

Hi doctor,

Thanks for the reply.

I am once again asking for help. This time for my second sister with cerebral palsy. You can see her history in my previous messages. She is 29 years old but only weighs 25 kg. She cannot speak, and she cannot sit or walk because of a distorted pelvic and spine. Now we think she has esophageal dysphagia. Please help us with what remedy we can do for her. I hope there is some medicine to relieve her pain. It is also causing her stomach to bloat. I will wait for your immediate response.

Answered by Dr. Aida Abaz Quka

Hello,

Welcome back to icliniq.com.

I understand your concern.

I would suggest performing a fibro gastroscopy, if possible, in order to investigate the possible causes of dysphagia. Anyway, I would suggest trying a PPI (Omeprazole or Pantoprazole) coupled with Diltiazem. If this does not help, I would suggest trying Idosorbide dinitrate, which can help in achalasia. These drugs should be done in combination with a gelly food (not hard and watery food) like pureed foods. If the above tips do not help, surgery may be necessary.

I hope you will find this answer helpful.

If you have any other questions, please don't hesitate to ask me again.

Kind regards.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Aida Abaz Quka
Dr. Aida Abaz Quka

Neurology

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