Suggest Treatment For Refractory Epilepsy

Posted on Tue, 3 Oct 2017

Question: My Dad is has epilepcy since he was 15. He is now 62 and is on multiple medicine but having fts daily and is taking time to recover. Can u suggest.

Answered by Dr. Ishu Bishnoi (1 hour later)

Brief Answer:
Epilepsy treatment

Detailed Answer:
Hi XXXXXXX thanks for asking from HCM.

I can understand your concern. Your father is suffering from refractory epilepsy. I need more information about his disease

- What anti epileptic drugs, is he taking?

- What is the report of EEG and MRI brain ?

- Is he totally complaint with medication or irregular intake?

In case of refractory epilepsy, the doctors first increase the dose of medication till maximum safe dose. If still no relief, he/she will add more medication and increase the dose. Usually 4 medications at maximum dose can be given. Upto 90% patients respond. In rest 10% cases, epilepsy surgery can be considered as one option.

Epilepsy surgery is decided based on

- MRI brain findings

- EEG findings

- 24 hour video EEG findings.

The results of epilepsy surgery are good if

- Focal epilepsy
- Well defined lesion in brain

Please provide me answers of above questions. I will guide you further.
Hope it will help.
Thanks

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Ishu Bishnoi (14 minutes later)

Medication: Levipil 1g twice a day
Dicorate ER 500 twice a day
Lacoset 100 mg twice a day
Gardenal 90 mg once a day
Rosifit CV 10 once a day
Eslo 5 mg for BP
Glimy M for Sugar

Roaufit added recently by an neurologist in XXXXXXX

Answered by Dr. Ishu Bishnoi (38 minutes later)

Brief Answer:
Antiepileptic medication

Detailed Answer:
Hi XXXXXXX welcome back.

Your father is taking four antiepileptic drugs
- Levetiracetam (Levipil) - maximum dose

- Lacosamide (Lacoset) - maximum dose

- Divalproate (Dicorate) - medium dose

- Phenobarbital (Gardenal) - medium dose

If still he is having seizures, then he must undergo fresh MRI brain and EEG to know the focus and epileptic current discharge area. Depending upon the report, he might be considered for epilepsy surgery.

If unfit for surgery, then the dose of Dicorate can be increased to 500mg (M), 250mg (afternoon) and 500mg (E). Serum level of each drug is needed to know if the drug concentration is adequate in blood or not.
Hope it will help. If still having doubts, do let me know.
Thanks. Take care

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Ishu Bishnoi (9 minutes later)

Thanks sir. That helps,
Having Sugar and BP issues No one is suggesting for surgery.
Can you please suggest a nuerologist in XXXXXXX

Answered by Dr. Ishu Bishnoi (2 hours later)

Brief Answer:
Thanks a lot for the appreciation

Detailed Answer:
Hi XXXXXXX welcome back.

I got your point. He is old age, having sugar and BP. Surgery in such case carries higher risk than normal. So continue with medication.

In XXXXXXX you should consult either Dr XXXXXXX XXXXXXX at KIMS. She runs epilepsy clinic and also select patients for epilepsy surgery. I have met her once during epilepsy workshop. I really liked her thorough knowledge about epilepsy.

I hope you will get best advise for your father.
Thanks. Take care.

Above answer was peer-reviewed by : Dr. Prasad