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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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