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How can recurrent seizures be managed?

Q: My 18 months old son is suffering from seizures after birth, but we recognise it 10 months back. The doctor suggested EEG and the result showed bilateral posterior hemispheric epileptogenic activity. Then we started these medicines – Biotin (20 mg) daily, Epilex syrup 1.5 ml thrice a day, Omnacortil (7.5 mg) daily in the morning and L-carnitine / cornitor 1 ml daily. MRI was also done which showed evidence of confluent hyper intensities involving bilateral peri-venticular white matter with mild atrophy. Subtle myelination of peri-venticular white matter and internal capsule is seen. There are capacious CSF spaces in bilateral Fronto-temporo-parietal regions. Rest of cerebral parenchyma is normal in signal intensity. Bilateral basal ganglia and thalami are normal in signal intensity. Ventricles are normal in shape, size outline and volume. Septum is in midline. Basal cisterns and sylvian fissures are normal. Sella and parasellar areas are normal. After a couple months, Omnacortil 7.5 mg was stopped and Epilex chorono (300 mg) was given and epilex syrup was stopped. After that he was alright. But four months back, seizures recurred at night with fever and remained for 20 minutes. How can recurrent seizures be managed?

A:I understand that the child has global developmental delay and symptomatic epilepsy. Your query does not give any indication of what could be the cause of the problem. Did the mother have any medical problems or complications during pregnancy? Was the growth of the baby and movements during pregnancy normal? Was the delivery normal, did the child cry after birth, how long did he stay in the nursery? When were the seizures noticed, what was the description of the fits, how many occurred in a day, did they occur on awakening? There are many more questions that need to be answered.

The prognosis depends on the disorder that is causing the seizures. I can only advise you that you continue the medicines. Get a developmental assessment done by a pediatrician or child neurologist. Get a repeat EEG done to see the nature of discharges. Ask your neurologist what the cause of epilepsy in your child is - the answer will tell how the child will do in future. He can also advise you the use of intranasal midazolam which you can administer to the child when he has a seizure - it is easy to use and will give you a lot of confidence in handling the fits. If the child's biotinidase level in blood is normal, then you can stop biotin. I would expect that a 1 year child be given epilex in a syrup form and the dose be divided into 2 times a day, at the least.

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