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Will surgery help my daughter's seizure problem?

Answered by: Dr. R. K. Sabharwal
Senior Consultant Paediatric,
Sir Ganga Ram Hospital,
New Delhi

Q. My sister's 6-year-old daughter got seizures 2 years back. We tried many combinations of drugs, but till date we have no conclusion as to which combination needs to be continued. At present we are trying with this combination – Previous Dosage: Tegrital Syrup – Initially 4 months; Gardenal 15 ml – about 1 Year; Valparin 15 ml; Present Dosage: Oxeptal 450 mg – 1-0-1; Topamac 100 mg – 1-1/4-1; Lobazam 10 mg – 1-0-1; Levipil 500 mg – 1-0-1; Neurobrain – New Tablet started 2 days back. We are unable to decide the proper fixed dosage to continue. We took EEG and got normal report when she was having seizures. The doctor altered the combination and after a month we got abnormal report when she was not having seizures. Now, she has very mild seizures and there is no foam from the mouth. She just laughs abnormally, with her mouth and eyes moving from left or right. Some doctors suggest surgery, but will it really help us?

A.  The history of the child suggests that she is having Complex Partial Seizures. She is currently on 4 medications: this number of medicines makes titration difficult. It is easier to try on 2 medicines and push their doses to maximum before adding another medicine. Surgery has an important role to play provided there is a structural defect that can be easily removed by surgery. The plan should be: 1) Video EEG 2) A good quality MRI on a 1.5 T machine using an established epilepsy protocol. The purpose of these tests is to look for a surgically correctable cause. As regards the medicines, my suggestion would be: 1) Reduce Oxetal to 300 mg - 450 mg 2) Reduce Topamac to 100mg twice a day 3) Withdraw Lobazam gradually 4) Reduce Levepil to 250mg - 500mg Having said that, you will agree that the best person to deal with the problem there is your neurologist. The centre with the best expertise in epilepsy surgery in India is Sri Chitra Tirunal Institute in Trivandrum.

A.  The history of the child suggests that she is having Complex Partial Seizures. She is currently on 4 medications: this number of medicines makes titration difficult. It is easier to try on 2 medicines and push their doses to maximum before adding another medicine. Surgery has an important role to play provided there is a structural defect that can be easily removed by surgery. The plan should be: 1) Video EEG 2) A good quality MRI on a 1.5 T machine using an established epilepsy protocol. The purpose of these tests is to look for a surgically correctable cause. As regards the medicines, my suggestion would be: 1) Reduce Oxetal to 300 mg - 450 mg 2) Reduce Topamac to 100mg twice a day 3) Withdraw Lobazam gradually 4) Reduce Levepil to 250mg - 500mg Having said that, you will agree that the best person to deal with the problem there is your neurologist. The centre with the best expertise in epilepsy surgery in India is Sri Chitra Tirunal Institute in Trivandrum.

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