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are you there?
so I read your paragraph. this is obviously not an easy decision for you and your wife
do you have any family members with epilepsy
My nother-in-law had epilipsy but at a later age > 45
so she is used to having someone in the family with a seizure disorder
is that why she is hesitant?
She is hesitant because she is not sure of the side effects
ok that is much easier
My wife also feels that my daugher is subject to seizures only before sleeping but I am worried that it could happen any time
so your mother in law first of all, did she get her seizures from any one event of was it familial
I have to ask you some questions first and then we can discuss the nocturnal nature ok?
I think she got a it a coupel fo times and then she was cntorleed
I guess what I am asking is does your daughter have an official classification of her epilepsy , a diagnosis, and is that related to her grandmother?
I am note sure.
She had her second seizure yesterday and the doctor suggested that she take medications because she could be prone to more seizures
that is the biggest point in deciding where she is going to go
the truth is that you daughters doctor is absolutely correct. If she has had two or more seizures separated by time, then she is an epileptic and needs to go on meds
Is Kepra effective?
unitl she doesn't have a seizure for two years, after which an evaluation could be done to consider tapering her, but only if she did not have an epilepsy diagnosis that
suggested she didnt need it
Keppra is my favorite epilepsy med
ok.. so if I understand correctly, she can take Keppra and if she doesn't have any seizures for the next 2 years, she can be off the meds?
it is wonderful for young adults, I have one who is an alcoholic but has brain lesions, vascular lesions, that he has to take keppra, and he is able to drink on it (don't tell your daughtter that)
what you just wrote is not correct
I am going to get you the international classification of epilepsy, hang on
the story is that it depends what type of seizures she is having as to whether she needs meds for life
it depends on what her eeg looks like
and why she started having seizures
EEG now or 2 years later?
the eeg now, especially close to the time she had her seizure is the most important, if she is having seizures onthe meds, she needs an ambulatory 48 hour eeg that she can get at home to help in the diagnosis of her type of epilepsy
Either way, you are suggesting ( highly recommending ) that she be on meds immedietly due to the 2 seizures. Correct?
absolutely, and it is not because of "damage" to her brain from having seizures, it is because she can be swimming or on a high wire act and have a seizure all my epileptics are scarred because of having seizures when they cannot afford it
there is a prolonged type of seizure, called status epilepticus, that can kill her, but it is extremely rare, and it usually is because the patient cold turkeyed her meds and abruptly stopped
got it. In one of your responses, you mentioned seizures on the meds? in other words, meds can help but not totally prevent?
so it is a decision that is important, not only does she have to take it, but she has to keep taking it and not miss a dose
absolutely, the meds only prevent seizures, they don't cure the patient, and the patient can still seize, it calls for an adjustment or changing her meds if that happens, but even then you don't change the med just because she seized
topamax and keppra were probably suggested to be started together, with the plan that you could taper off the topamax and stay with just Keppra if she is seizure free
after a few months to half a year
it is a good combination for a young girl, you dont haveto worry about liver functions, you don't have to check blood levels, it doesn't affect her hormones, etc
Last question, does the fact that the second seizure lasted only 30 secs make any difference?
not really. if you have two seizures together or a run of them, we call that in terms of the brain changes as a single event. but if you have them daily, or a couple times a week with normal periods in between, then you are looking at medication for a longer period. are these tonic clonic seizures where she loses conciousness, bites her tongue, and incontinence?
or just staring spells
Yes, she did lose consciouness both times and bit her tongue and stared as well
and she jerked on both sides?
I think she jerked on the left side only
ok. and her MRI is clean?
MRI is clean. Thankfully
as a general term across all epileptics, the chance that she will outgrow this is about 33%
but that figure isn't really helpful as it is purely an individual thing, not all epileptics are alike
she didn't have febrile seizures as an infant did she?
Overall. she can lead a normal life on the meds?is that correct? she is a nationally ranked table tennis player in her age and she works very hard at it and we feel maybe she is getting too fatogued and teh seizures are a result of that
She had one febrile seizure
that is a distinct possibility. one thing I want to tell you is that some people call topamax, dopamax because it can make you dopy, so her table tennis might suffer, you will have to keep an eye on that, the keppra though should not effect her
it is sounding like she might need to stay on meds.
at least there are studies that say febrile, then tonic clonic in adolescents, that you may need meds
hang on, i can find that abstract
So we can't assume that the seizure will occur only when she is sleeping ( even though that is what has happened to her the last 2 times ). Her doc said that it could happen at any time.
seizures have a tendency to start in the transition from awake to sleep and vice versa, we know that, but they also can occur during the day. so you have to be prepared, she will declare herself in the next year or two if she is going to have daytime seizures. it could be that stress serves as a trigger for her seizures
this paper says that the longer you go after a febile seizure before the first tonic clonic seizure, the better the chance that you won't have them life long
so she went probably 12 years or so
That is correct - 12 years
I think that is pretty good news for her, but you will have to wait to find out
do you have any more questions, if you do, please come back and we can discuss ok? if you feel I answered your question, please hit the accept button as that is how I am compensated for my work, and youcan always come back
Thanks Doc. I am preserving this chat session for and send to my wife,