Q: My 3.6 years old son is suffering from drop or fall attacks for a year. He has a postnatal history of septicemia due to which his blood sugar once dropped very low to 15 mg/dl only. His milestones are normal i.e. sitting, walking, recognition except for speech, which is not clear. But now due to infantile spasms or drop attacks, he is showing regression and has become much slower and his body balance has also got disturbed. He walks right but runs uncoordinated. Though not an autistic, he shows signs of Pervasive Development Disability (PDD). He is right now on anticonvulsive drugs- Topamac, Lamosyn, Valparin and Sabril. We have also started giving with Ketodiet, which is showing positive signs. His MRI reports cerebral atrophy, ventricular enlargement, disturbed EEG and bilateral epileptic activity. I would like to know what will be his state in future with respect to his development, movement and occurrence of the convulsions, also how much can a surgery control drop attacks?

A:Your child suffered Sepsis and Hypoglycemic Encephalopathy that has resulted in Infantile Spasms and a secondary autistic spectrum disorder. Regrettably, this is an unpleasant combination of disorders. If he is still having jerks, the doses of medicines may need to be adjusted. You should know that Lamosyn may help in drop attacks, but can increase the myoclonic jerks. Similarly, Sabril can control, and also increase the jerks. This can be detected by checking whether the jerks increased after increasing the dose of Sabril. A good combination would be Valparin with Lamosyn (if it does not increase the jerks) with small doses of Topamac. You should be careful when using Topamac with Ketogenic diet. But, I am sure your neurologist would have that in mind. Other drugs include steroids/ACTH, and benzodiazepines. Ketogenic diet if planned properly is very helpful. Some forms of surgery are available that may help in the drop attacks and generalised fits, but may not completely abolish them. I think the Sree Chitra Tirunal Institute at Trivandarum is doing good work in Epilepsy Surgery.