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Old 08-10-2008, 07:47 PM   #1
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Seizure change and medicine

A brief history. My MR adult son started having seizures 2 years ago. He has had 4 so far. (8/06, 10/07, 1/08, 8/08) After the 3rd we started on Keppra 500mg AM and 500mg PM.
He just had his 4th one the other night. This one was totally different then the first 3. The first 3 were your classic tonic clonic. Seizure lasting < 5 minutes and total recovery taking several hours. All of these have been in his sleep But around 10pm. The other night at 10:10 pm he was sitting on the recliner listening to his walkman. He got off the recliner with a fearful look and covered his right ear and started turning in circles. He was rigid, but not a lot, sat him on a chair and within 3 minutes he was back to himself.
He said that his ear was popping and he had a headache. Call the neuro and he increased his PM dose to 750mgs.

We just a week earlier got his latest EEG report that said, "no focal or paroxysmal discharges were seen,there were no epileptic form discharges.
It did state that it was a slow and disorganized EEG, largely 6.5-7HZ. These findings are explainable on the basic of a static encephalopathy.(Which means do to his brain damage his waves slow and disorganized.)

My take on all of this is that the Keppra is working we just need to tweak it a little. Anyone have any thoughts?

 
Old 08-14-2008, 04:06 AM   #2
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Re: Seizure change and medicine

Thoughts anyone???

 
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Old 08-14-2008, 06:20 AM   #3
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Re: Seizure change and medicine

cas, if indeed epilepsy showed in his EEG before, it does sound like the medicine is having an effect. Would you characterize the 4th seizure as less severe than the others? If so - and it sounds like it was to me - that's even better news. The timing, of course, isn't such good news, but with such a short history it's going to be hard to tell what is normal. Of course, epilepsy changes over time, too.

As a side note, most neuros don't want complete control of epilepsy. It's probably too cynical to assume that's for their own benefit, because there is research showing that complete control can lead to psychosis. So it's a matter of seeing, over time, what level of control you can realistically expect and tolerate.

I think your conclusion about the medication is right.

 
Old 08-14-2008, 08:54 PM   #4
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Re: Seizure change and medicine

Or maybe the keppra is not working as well as I thought. He had a tonic clonic seizure this evening. He had never had 2 in a weeks time. Prior to this the closest time frame was 3 months. Guess we will check in with the Dr. in the morning. Question for anyone. He gets his AM Keppra with his breakfast around 6:30 am. Then his evening dose with his bedtime routine around 9Pm. Thats about 15 hours apart. Should I be giving his PM dose closer to the 12 hour mark? Say maybe around dinner time? Would that 3 hours make a difference? Thats one question I will ask the DR. in the morning.

 
Old 08-15-2008, 04:48 AM   #5
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Re: Seizure change and medicine

Quote:
Originally Posted by Mediocrates View Post
cas, if indeed epilepsy showed in his EEG before, it does sound like the medicine is having an effect. Would you characterize the 4th seizure as less severe than the others? If so - and it sounds like it was to me - that's even better news. The timing, of course, isn't such good news, but with such a short history it's going to be hard to tell what is normal. Of course, epilepsy changes over time, too.

As a side note, most neuros don't want complete control of epilepsy. It's probably too cynical to assume that's for their own benefit, because there is research showing that complete control can lead to psychosis. So it's a matter of seeing, over time, what level of control you can realistically expect and tolerate.

I think your conclusion about the medication is right.
Can you please explain what you meant by "complete control can lead to psychosis"? I was a bit surprised by this comment, can you please elaborate?
By any chance, are you in the medical profession?

 
Old 08-15-2008, 06:36 AM   #6
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Re: Seizure change and medicine

life, I am not in the medical profession, so take my comments with that in mind.

However, my comment concerning psychosis is something I found after being diagnosed with adult-onset, intractible e. I confirmed this with my neurologist - not really the academic finding, but that they were not concerned with fully controlling my seizures. A few per year, all nocturnal and of the same type is unremarkable to my neurologist and is as good as can be expected. It was difficult for me to let go of the notion of returning to my former seizure-free life. I have been assimilated, as it were.

I didn't save the original source; this was several years ago. The clearest statement concerning seizures and complete control I've found this morning is from Schizophrenia-Like Psychosis and Epilepsy: The Status of the Association in The American Journal of Psychiatry (Am J Psychiatry 155:325-336, March 1998).

Quote:
Brief psychotic episodes can also develop when seizures are infrequent or fully controlled. These psychoses last from days to weeks, they are usually self-limiting, and their separation from postictal psychoses may be difficult. The favored description is of an alternating psychosis... Unlike postictal psychosis, this psychosis can be ameliorated by the occurrence of one or more seizures (39).
[url]http://ajp.psychiatryonline.org/cgi/content/full/155/3/325[/url]

A more general source:
[url]http://professionals.epilepsy.com/page/psysym_forced.html[/url]

So, it sounds like they are brief psychotic episodes, rather than cases of full-blown psychosis, but it's the same to me. If they keep me sane, I'll stick with my seizures under reasonably good control.

As I mentioned, I didn't confirm my layman's understanding of this with my neurologist, but it seems clear. I expect this is more of a problem with intractible epilepsy over an extended period than when only a few seizures have occurred, but that's just speculation on my part.

 
Old 08-15-2008, 06:41 AM   #7
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Re: Seizure change and medicine

Quote:
Originally Posted by cas526 View Post
Should I be giving his PM dose closer to the 12 hour mark? Say maybe around dinner time? Would that 3 hours make a difference? Thats one question I will ask the DR. in the morning.
cas, sorry to hear this. Hope you and your doctor can resolve this soon.

You probably already have your answer, but they should be spaced 12 hours apart. With carbatrol, I've found that even an hour off can make a difference; less than an hour doesn't seem to matter. I simply set alarms on my cell and forget about it.

Last edited by Mediocrates; 08-15-2008 at 06:47 AM.

 
Old 08-15-2008, 11:11 AM   #8
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Re: Seizure change and medicine

Thank you for those links, Mediocrates. I guess having a seizure every once in awhile isn't such a bad thing afterall, lol.

 
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