I have focal epilepsy. Can EEG track my treatment response?

Question

Hello doctor,

I am 28, diagnosed with focal epilepsy last year after two episodes of partial seizures. My recent EEG shows abnormal discharges in the left temporal lobe, and the MRI of my brain showed no structural issues.

Currently on Levetiracetam 500 mg twice daily, but I still had a mild seizure last week lasting 40 seconds. My vitamin B12 came to 198 pg/mL, slightly low, and my sodium levels are 133 mmol/L. So my concerns are -

Should I consider shifting to Lamotrigine or combination therapy instead?
Also, is it safe to drive after being seizure-free for three months?
Would an updated EEG help monitor treatment response better in my situation?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand how unsettling it must feel to still have breakthrough seizures despite being on treatment, and it is good that you are monitoring both your laboratory test reports and symptoms closely.

Since your seizures are focal (temporal lobe) and you have had a recent breakthrough on Levetiracetam 500 mg twice daily, your neurologist may consider either increasing the dose (as it can often be safely titrated higher if tolerated) or switching or adding another antiseizure medication like Lamotrigine, which is effective for focal epilepsy.

Sometimes, combination therapy is needed if one drug alone does not fully control seizures, but your treating neurologist should carefully decide this.

Your slightly low vitamin B12 and mildly low sodium may not directly cause seizures, but can worsen neurological symptoms, so correcting these is important.

Regarding driving, most countries recommend being seizure-free for at least six to 12 months before resuming driving, so three months would still be considered too soon. It is best to follow local regulations for safety.

An updated EEG can sometimes help assess ongoing epileptic activity and guide treatment, but the main focus remains on clinical seizure control. You are not alone in this journey. Many people need adjustments in medication before finding the best control, and with careful follow-up and lifestyle precautions, your outlook remains very positive.

I hope this helps. Always feel free to reach out at any time. I am always here to help.

Thank you and take care.

Regards.