My 16-year old daughter’s seizure / epilepsy medication?
My daughter aged 16yrs , had first seizure in school in October,2000 at the age of 12 yrs.Carried out EEG and MRI.The result of MRI was normal.The result of EEG showed paroxysmal activity i.e epileptiform .Doctors advised that they do not prescribe any medicines after first seizure and wait for sometime.She had no seizures for the next two years.Then she had seizure / fit on 23rd. February,2003.The Doctor advised Tegral (200 mg)1/2 + 1/2 daily. But she was having seizure / fit followed vomitting and headache every five to six months since Feb,2003.
On 2nd December,2004 we consulted another Doctor who advised the following medicines whe we are giving since then.
1. Tegral - One tablet in morning and 1/4 tablet at night.
2. Epival 250 mg- One tablet in the morning and one at night.
3. Phenobarbitone(30gr) - One tablet at night.
4. Neurocoline Injection - One injection every week for 8 weeks.
( Total 8 injections)
Pls advise if epilepsy is curable or require permanent/continuous medication to avoid fits
Dr. Joshua’s answer:
Monotherapy (just one single drug) is always recommended if possible for epilepsy / seizures. In your daughter’s case, carbamazepine (Tegral) was started, but was the serum carbamazepine concentration monitored? Also, she has grown since then, and she may have required a larger dose. 100 mg twice daily may have been an insufficient dose of carbamazepine. For a 16-year-old, larger doses may be needed. Lab tests for the serum drug concentration should be monitored in order to find the right dose.
However, if carbamazepine alone is not sufficient, drugs such as Epival (valproic acid) may be added as an adjuvant. It seems that a barbiturate has also been added (phenobarbitone).
Phenobarbital is mainly used for in infants, not commonly in adults or teenagers. Phenobarbital and other barbiturates are problematic especially because of their interactions with the other drugs - the blood concentrations of Tegral and Epival may be affected by the phenobarbital.
I recommend you visit a neurologist to review the current epilepsy medication: Serum concentrations of Tegral and Epival should be controlled - the two drugs interact with each other in the liver and, consequently, the dosing may not be optimal. Additionally, the necessity of phenobarbital should be carefully considered. Monotherapy with just Tegral alone might be sufficient for your daughter, if the dosing is adequate? However, please do NOT make any medication changes on your own after reading this - any epilepsy medication changes need to be done in a controlled manner.
Also, liver function and blood cell lab tests need to be controlled from time to time with any antiepileptic drug treatment.
As for your question about whether epilepsy is curable - it depends on what causes the seizures. If possible, I’d recommend a new MRI especially if the frequency of the seizures is increasing. A repeat EEG would also be good. If no cause can be determined, childhood epilepsy may resolve by itself over time. However, sometimes life-long antiepileptic medication may be needed.
If for some reason you do not have access to a neurologist, or get an MRI done, please write to me again with as much detail as possible (see also the before-you-post checklist) and I’ll see if I can help you more with this.
As for the Neurocoline - it’s beyond my expertise, but I suspect it won’t have an effect either way. It’s generally considered alternative-ish medicine in the treatment of seizures / epilepsy.
Sincerely,
Dr. Joshua
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