Q: My 31-year-old wife is suffering from epilepsy for the last 11 years. Initially, she was prescribed Tegrital 100 mg twice a day and then the dose was increased to 200 mg twice a day. We got married eight years back, and soon after she got fits twice in three months. At that time, she was pregnant and was suffering from jaundice. She took medication for jaundice, and then for almost three years there was no problem. Then she was pregnant for the second time and again she got fits. The doctors advised her to increase the dosage to 400 mg twice daily. Again she had no problem for the next three years, and the doctors reduced her dosage to 200 mg twice a day. But she has started getting fits again, once last year, another two months back, and the third four days back. The fit lasts for 3-4 minutes and then she becomes normal. Since we are staying at a different place now, I got her admitted in a hospital for three days. The doctor here has prescribed Epsolin 100 mg thrice a day (although he was informed that she was taking Tegrital). She underwent a CT scan, which was normal, and all other related blood tests were also normal. Why is she getting these fits? Will the change of medicine have any side effect? Is Epsolin better than Tegrital?

A:Idiopathic epilepsy is a disease of electrical currents (so to say) that precipitate seizures by hitting a motor area in the brain. Hence CT scan (which only looks at the size and shape of brain) and blood tests are nearly always normal. The only test that can show the disorder is an EEG. There is no mention of this test though I think it would no longer help at this stage. It is done in the initial stages to confirm epilepsy and not to treat. The normal, usual adult dose of carbamazepine (sold as Tegrital, etc.) is 400 mg 2-3 times (1200 mg) daily though one can go to even 1600-2000 mg in resistant cases. It appears that the patient was doing fine at 400 mg twice a day. The attending doctor attempted to decrease the dose which is a good clinical practice. However, once this did not succeed, the best course of action was to revert to 400 mg twice a day (800 mg daily), which in itself is quite a moderate dose. Only when a patient does not respond to maximally tolerated doses of a drug, should one change the medication. Epsolin (phenytoin sodium) is neither better nor worse than carbamazepine. It is just different. Now that the medicine has been changed, let us see if she responds to the new drug. The usual initial dose is 150-300 mg daily to be increased to 200-400 mg daily as per response. Maximum allowed is 600 mg daily.