How to assess seizure control for a 28-year-old?

Question

Hello doctor,

I am 28 years old and was diagnosed with epilepsy following a generalized tonic-clonic seizure last year. My EEG showed abnormal activity in the left temporal region, and I have been taking levetiracetam 500 mg twice daily since then. I have not had another major seizure but am frequently spaced out and fatigued. MRI results were normal. I live alone and am concerned about the possibility of having another unexpected seizure. How can I gauge whether my condition is stable or my treatment might need adjustment?

Thank you.

Answer 1

Hi,

Welcome to icliniq.com. I read your query and can understand your concern.

1. Understanding your epilepsy

You had a major seizure last year, and your electroencephalogram (EEG) indicated seizure activity arising from the left temporal region. The magnetic resonance imaging (MRI) was normal, and that is reassuring. This type of epilepsy is often very manageable with medication.

2. Are you stable now?

You have been seizure-free for a whole year, thus showing that the present treatment is working for you. The continued feelings of being "spaced out" or fatigued do need attention, since they could be related to mild seizure activity or medication side effects.

3. Reasons why one may feel spaced out:

Levetiracetam can cause fatigue, low energy, or mood-related symptoms for some people. Sometimes short "mini-seizures" can cause brief blank spells, too. For some people, stress, poor sleep, or anxiety can make these sensations more noticeable, but it does not necessarily mean your epilepsy is getting worse.

4. When treatment may need adjustment:

If you are often feeling tired or having short blank episodes, your medication dose may need to be reviewed. Some people find that increasing to 750 to 1000 mg twice a day is beneficial, or adding vitamin B6 helps with tiredness or irritability. If symptoms persist, then your neurologist may recommend that an EEG be repeated.

5. Living alone with epilepsy:

You can continue to live independently with some simple safety precautions. Take your medication as directed, get good sleep, and avoid alcohol, recreational drugs, or skipped dosages. Keep your phone close by and take showers instead of tub baths for safety.

6. Warning signs to watch for:

Watch for possible symptoms of nighttime or subtle seizures: sudden confusion, staring blankly, déjà vu sensations, unusual smells, or waking up with a headache or bitten tongue.

7. Reassurance:

Overall, you are doing very well. You have had no seizures in a year, which is a very encouraging sign. Your symptoms are common and often manageable; many people with conditions like this lead fully independent, normal lives.

8. Next steps:

Consider maintaining a simple symptom diary, and schedule an appointment to discuss possible medication adjustments with your neurologist. If you find yourself feeling tired, it may be helpful to check your vitamin levels. A repeat EEG is normally not necessary unless your symptoms persist.

I hope the information helps.

Kindly revert so I can assist you further.

Thank you.