After starting the above mentioned dose from 03/12/04 , Serum & LFT test was taken on 06/12/04 and the results are:
Serum carbamazepine - 12.770 ug/ml
valproic acid - 82.420 ug/ml
On the basis of the above report , Doctor reduced the amount of Tegral (carbamazepine) to 1 tablet morning and 1/4 tablet night time.Kindly advise.
Referring to earlier days , she had high temperature/fever when she was very young between 2 yrs and 5 yrs. and her eye sight is also weak.(-7.00) . Are they related to epilepsy?
I am awaitnig yr advice about doses of medicines and if you advise , will carry out MRI ? EEG and Serum test again
Dr Joshua’s answer
Seems like the reduction in carbamazepine was in order - the concentration was a bit too high. However, testing carbamazepine concentration alone may not be sufficient when valproic acid is used simultaneously: carbamazepine has active metabolites (i.e. by-products of carbamazepine metabolism in the body), and their concentration may be increased with valproic acid treatment and would have to be measured separately, especially if toxic effects of carbamazepine are suspected, but this is rarely done. The point I’m trying to make is that monotherapy (single drug) if possible is better and simpler to follow-up. It’s not always sufficient, though. The protein and albumin concentrations were a bit high - this may be just due to dehydration - might be good to check these again when she has her next lab tests taken.
It seems to me your daughter has been adequately followed up. Any alterations to doses or prescriptions of carbamazepine, valproic acid or any other drugs will have to be done by your daughter’s attending physician - I cannot give treatment via the internet, only information. May I stress that you must not alter her medication based on any advice you are given on the internet. Always follow her own doctor’s orders exactly. Based on the information you have given me I presume that you have access to neurological services, and I recommend you discuss your questions with a local neurologist.
Whether the myopia (weak eyesight) is related to the epilepsy, I cannot say for sure. Usually not - I suspect such a thing might be seen with some developmental disorders/syndromes with seizures. I don’t quite understand what you mean by the high fever between ages 2 and 5 - if she had one serious infection, especially meningitis, that might be the cause of the epilepsy, but other than that, based on the available information I cannot say.
Repeat MRI or EEG could be indicated if the frequency of the seizures is increasing or the epilepsy is becoming resistant to drugs. Whether these are to be done should be discussed with your daughter’s own neurologist. I cannot directly recommend expensive investigations without profound knowledge of your daughter’s illness. Video-EEG may also be an option if the nature of the seizures is unclear. Please discuss these with your neurologist before proceeding.
I believe I have provided everything I can in the circumstances. Anything more specific will have to be done by your own neurologist. I hope this discussion has been of some help to you, and I wish you and your daughter all the best.
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