How to manage my 19-year-old son's recurrent seizures?

Question

Hello doctor,

My 19-year-old son has been experiencing recurrent seizures despite being on antiepileptic medication for almost one year. His episodes are mostly generalized, but he sometimes has brief staring spells as well. There is concern about the impact of these seizures on his education and driving eligibility.

Should medication adjustments be explored, newer medications considered, or surgical options evaluated?
How often should electroencephalograms (EEGs) be repeated to assess seizure control?

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

If your son is still experiencing seizures despite taking antiepileptic medication regularly for nearly one year, it indicates that his epilepsy is not yet fully controlled. The neurologist may consider the following steps:

Re-evaluating the dose and blood level of his current antiepileptic drug (AED). In some cases, even small dose adjustments can improve seizure control.
Switching to or adding a newer medication such as Levetiracetam, Lamotrigine, Brivaracetam, or Perampanel, depending on the seizure type and potential side effects.
Assessing medication compliance, sleep patterns, stress levels, and seizure triggers, as these factors can significantly influence seizure control.

If seizures continue despite the use of two appropriately chosen antiepileptic drugs at adequate doses, the condition is referred to as drug-resistant epilepsy (DRE). In such cases, evaluation at a comprehensive epilepsy center is recommended.

This evaluation may include:

Video electroencephalogram (EEG) monitoring.
Brain magnetic resonance imaging (MRI).
Positron emission tomography (PET) or single-photon emission computed tomography (SPECT) scans.

Based on the findings, treatment options may include epilepsy surgery, vagus nerve stimulation, or newer therapies such as responsive neurostimulation (RNS) or deep brain stimulation (DBS) in selected cases.

A routine electroencephalogram (EEG) is useful when the diagnosis or seizure type needs confirmation. After treatment has started, repeating the EEG every six to twelve months is reasonable if seizures persist or medications are adjusted. In patients with well-controlled seizures, frequent EEG testing is usually not necessary unless there is a recurrence.

Driving should be avoided until the individual has been seizure-free for at least one year, in accordance with most legal and safety guidelines. Educational support measures such as flexible schedules, stress management, and good sleep hygiene are important to support learning and academic performance.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.