Q: My 19 years old wife is suffering from temporal lobe epilepsy. She got her first attack 4 months back. The doctor advised CT-scan and EEG. After checking the reports the neurologist diagnosed that my wife had a problem of brain seizure called temporal lobe epilepsy, and it takes around 3 years to recover. He prescribed Oxetol-300 and Gardenal-60 twice daily. She is allergic to eptoin. Is the treatment appropriate?

A:From the treatment angle, epilepsy is divided into several sub-groups such as Grand mal (also called generalised tonic clonic), partial (focal) seizures and Petit mal (absence seizures where there are usually no visible convulsions). You have not given any information on the attack of fits - for how long it lasted? Did she fall down? I presume the specific diagnosis is Grand mal (generalised tonic clonic). An attempt should always be made to control convulsions with just one drug: carbamazepine (sold as Mazetol, Tegrital, etc.) or phenytoin (sold as Epsolin, Eptoin, etc). These are the first options. Since the patient is allergic to Phenytoin (Epsolin), the logical first option would be carbamazepine i.e. Mazetol or Tegrital 200 mg twice daily increasing to 400 mg 2-3 times daily, if required. If convulsions are not controlled with optimal dose, then a second drug can be added such as phenobarbitone (sold as Gardenal) 60 mg or more up to 240 mg daily. Carbamazepine is internationally approved for use in generalised tonic clonic and partial seizures. Oxetol 300 contains oxcarbazepine, which is approved for use in Partial seizures only. Apart from that it is far more expensive with no additional advantage. The cost of Mazetol SR 300 mg is Rs. 25 while Oxetol costs double i.e. Rs. 50. If the diagnosis is Partial seizures then one can use both carbamazepine (Mazetol or Tegrital) and oxcarbazepine (sold as Oxetol, Oxrate etc). However, if the diagnosis is Grand mal (generalised tonic clonic), then only carbamazepine (Mazetol or Tegrital) is to be used. In case of doubt one should use carbamazepine since it can be used in both generalised as well as partial seizures.