Q: My 72 years old father-in-law suffered from a hemorrhagic stroke six months back. He underwent a brain surgery to remove the haematoma. He is now recovering from his surgery. He is still paralytic in both the limbs on the left side and undergoing physiotherapy. He has been taking Eptoin 100 (thrice a day) for around three months. Now, the doctor has asked him to reduce the dosage to Eptoin 100 (once a day). He has not suffered any fit or seizure during this period and is also fully alert. His drowsiness has also reduced after reducing the dosage of Eptoin. Besides Eptoin, he is taking medicines to control blood pressure (Amtas 10 and Cardivas 6.25 twice a day). His blood pressure ranges around 150-90 mmHg.

A:Many patients of haemorrhagic / bleeding stroke develop seizures, and sometimes seizures may cause further complications in a stroke patient. Brain surgery further increases the risk of seizures. Hence it is an established practice to start antiepileptic drugs, most commonly Eptoin, in these patients.

If the patient is now stable, and has not had any seizures till now, it would be advisable to gradually reduce and eventually stop Eptoin over 3 months. It is essential to reduce Eptoin very gradually, as Eptoin itself may have been the reason that the patient has not had any seizures after stroke / brain surgery, and withdrawing this drug may precipitate a seizure. Some doctors advise doing an Electroencephalograph (EEG) test before reducing or stopping antiepileptic drugs. If this test is abnormal, it is advisable to continue full dose (100 mg three times a day) of Eptoin till atleast three years.

After a month of current dose of 100 mg per day, you may want to stop Eptoin under guidance of your physician. The other drugs need to be continued as per your physician's advice, as long as the blood pressure is abnormal. A lipid profile test should be done, and if abnormal, treatment to lower cholesterol should be started. Also, if the patient is having low levels of Vitamin B12, supplements should be given.

Physiotherapy should continue for as long as possible (approximately till the end of one year) after stroke.