What is the treatment for sudden seizures and dermoid cyst?

Question

Hi doctor,

My mom is 65 years of age. Since age 28, she had started to get severe headaches, and they worsened day by day. Doctors monitored the reasons but could not find a solution and put her on migraine medications Inderal and told her to sleep. A CT scan was also done, and the results were normal. She had a massive screech and went into a fatal seizure. It happened again in a short while, and doctor was called and suggested her to the emergency and get a CT scan, and CT revealed there was a cyst in the brain that got ruptured. She was sedated with medicines and was on observation for many days in the hospital, where doctors concluded it was a dermoid cyst that had ruptured eventually, many had advised for taking her for surgery, but then a panel of doctors decided not to do any surgery and keep her on Phenytoin and other medicines like Inderal and Frisium. It took more than six months for her to start moving. Gradually her life normalized, but she was limited to many daily activities as sleep, headaches, and medication did not get her back to an everyday active life. She had low vitamin D and vitamin B12, and T4 was slightly below range. Her doctor increased her Phenytoin medicine from 200 mg to 300 mg, including her regular medicine as Inderal 20 mg, adding Lexotanil 3 mg at night and 1.5 mg a day, and the physician put her on vitamin D and B12 every week for eight weeks. But mom had a mild seizure, and the neurologist increased her dosage of Epanutin to 300 mg on alternative nights and 200 mg the other alternative nights with a regular daily 100 mg Epanutin daily in the evenings this is including all her other medications. She had a mild seizure, and the next night just before sleeping, she had a big seizure after consuming her Epanutin dose. The recent MRI showed the dermoid cyst as before in size, and the doctor showed satisfaction. Kindly advise, despite all her increased medications, how can she has suddenly gotten these seizures? She also complains of lower back aches. Please help.

Thanks.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Per your description, your mom has seizures despite two good antiepileptic medications. In such cases:

1. First need to conclude whether her minor seizures are actual seizures or some other thing- like pseudoseizure, conversion, etc. It requires detailed history-taking and clinical judgment.

2. If those seem like actual seizures, then she might require long-term video EEG (electroencephalogram) monitoring to determine the focus of those seizures.

3. If the focus of seizures is found to be only from the area of the dermoid cyst, there may be a benefit in seizure control by doing surgery for it.

4. If the focus is different or multiple foci, the only option is adding a third antiepileptic medication.

If these facilities are available in your place, you can discuss them with your neurologist.

I hope this information will help you.

Thanks.