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Does my son need treatment for rolandic epilepsy?

Q: My son was 7 years old when he got his first seizure. The second seizure happened about 3 months after the first one. The doctor treated this as roladic epilepsy and prescribed Topomac 25 mg at night. The initial course duration was 2 years. His MRI and EEG were done and the MRI was normal but there was some abnormality in the EEG. During the 2 years of medication, he was free of seizures. When we tapered off the medicine and finally stopped them, he got a mild seizure after one month of stopping. Again Topomac 25 mg was started at night. Six months later, he got a high intensity seizure at during his asleep. His body became stiff and started jerking for 2 minutes. He passed saliva and urine also and vomited after 15 minutes. The doctor advised to give him 25 mg Topomac in the morning and at night. All these seizures occurred after 3-4 days of his school examination and were during the start or end of sleep. Is this type of epilepsy curable? Is his treatment going in the right direction? How much time does it takes to fully cure this epilepsy? Will the medicine have any kind of side effect on his school performance? He is studying in 6th standard. Does this have any relationship with stress during school examinations?

A:The typical Rolandic Epilepsy is considered to be a benign epilepsy, which some experts, not all, never treated till recently. The reason for this was that majority of children had 1 or 2 seizures, usually 3 or less. The brain remained normal and the child outgrew the epilepsy. The diagnosis of Rolandic Epilepsy is based on description of seizures and a typical EEG pattern. Some benign Rolandic epilepsies may not be so benign also. I think you should get a repeat EEG (sleep record and wake him towards the last 5 minutes of the recording.) I would like to use small doses (5-8 mg/kg/day) of Tegretal in lieu of Topamac. If he has more seizures, then I would revise my diagnosis of Benign Rolandic Epilepsy.

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