My mother is an epileptic patient.I want to know if her present treatment is right?

Question

Hello doctor,

My mother is a patient of epilepsy for 22 years. Earlier she was diagnosed as GTCS (generalized tonic-clonic seizures) and CPS (complex partial seizures) and given Eptoin 100mg BD at first, then Zeptol CR 400mg BD with Cloba 10mg for fits, convulsions, and senselessness. But still, it was going on. Now, for the last two years, we consulted another doctor, who diagnosed that her treatment was not in the right way. He said that the seizure was idiopathic generalized epilepsy with absence seizures and she was given Encorate Chrono 500mg BD with Cloba 10mg.

After this, she was good for two years. Then she again developed fits, senselessness, and convulsions this year. So, we went to the doctor and this time the diagnosis is combination of multiple seizures with psychogenic non-epileptic seizure and was given Encorate Chrono 500mg BD, Levipil 500mg BD, Cloba 10mg HS, Nexito 10mg HS. But still fits and convulsion is going on after coming back from the hospital. Please advise what has to be done. Is the treatment going in the right way? Is there any need for medicines such as Topiramate or Lacosamide or Tiagabine medicines?

Answer 1

Hello,

Welcome to icliniq.com.

Your mother's situation seems to be very complicated.

I would like to explain that it is true that Carbamazepine (Zeptol) can have no good effect or even worsen idiopathic generalized seizures.

I would not recommend Topiramate for this type of epilepsy, because it is more effective in partial epilepsy.
This is a case of drug-resistant epilepsy, where it is known (during many studies) that when 2 antiepileptic drugs are not effective, the possibility to have success with other antiepileptics is very low.
But I would recommend tryingraising the doses of Encorate (Valproate) or Cloba (Clobazam).

The valproate plasma levels should also be performed, to know if she is being treated with the right doses of Encorate Chrono.

I would recommend performing a brain MRI and a careful EEG to establish any possible cause of these seizures, which could be treated by a possible brain intervention.

I would also reconsider the treatment with Escitalopram (Nexito), as it is an SSRI(Selective Serotonin Reuptake Inhibitor) and in rare cases has been shown to aggravate the seizures.

Hope it was helpful.