Occasional Seizures in Long-Term Epilepsy Management

Q: Occasional Seizures in Long-Term Epilepsy Management

Hello： I am not sure what the cause of your epilepsy is. <br>Typically, epilepsy can be triggered by various specific conditions that affect brain tissue. <br>For example, head injuries that lead to brain tissue damage, injuries at birth or high fever, certain medications or toxi

Epileptic seizure

Hello Dr.
Junyi, I have been taking medication for epilepsy for nearly 6.7 years.
It has been relatively well-controlled, but I still experience occasional focal seizures.
My medication dosage has been increasing; initially, I was taking one tablet of Lamotrigine in the morning and evening.
Recently, it was changed to one tablet in the morning, one tablet in the evening, and one tablet at bedtime.
Now, I am taking two tablets in the morning and one tablet each in the evening and at bedtime (Morning - one tablet of Lamotrigine and one tablet of Topiramate, Evening - one tablet of Lamotrigine, Bedtime - one tablet of Topiramate).

paul Yu, 20~29 year old female. Ask Date: 2018/02/26

Dr. Jiang Junyi reply Neurology

Hello: I am not sure what the cause of your epilepsy is.
Typically, epilepsy can be triggered by various specific conditions that affect brain tissue.
For example, head injuries that lead to brain tissue damage, injuries at birth or high fever, certain medications or toxic substances that harm the brain, or conditions such as stroke, tumors, or cardiac and circulatory issues that obstruct blood flow to the brain.
Diseases that damage brain neurons include meningitis, mumps, and measles.
Additionally, certain conditions can destabilize brain cells, such as stress, hypoglycemia, fever, and lack of sleep.
However, it is important to note that suddenly stopping or changing antiepileptic medications can also lead to severe seizures.
Currently, you are using second-generation medications, which are more difficult to monitor for drug levels.
If Trileptal exceeds 2000 mg, you might consider adding a second medication, such as your current Topamax.
I recommend discussing your examination and treatment options with a neurologist.
Wishing you good health, peace, and joy.
Dr.
Tao cares about you.

Reply Date: 2018/02/26

More Info

Managing epilepsy, particularly in the context of long-term treatment, can be complex and often requires a nuanced understanding of both the condition and the medications involved. It is commendable that you have been proactive in managing your epilepsy for the past 6.7 years, and it’s understandable to have concerns regarding occasional seizures despite adherence to your medication regimen.

First, it is important to recognize that epilepsy is a chronic neurological disorder characterized by recurrent seizures. The goal of treatment is to achieve seizure control while minimizing side effects from medications. However, achieving complete seizure freedom can be challenging for many individuals. The fact that you are experiencing occasional seizures, even with an increased dosage of your medications, is not uncommon in epilepsy management.

There are several factors that could contribute to the persistence of seizures despite ongoing treatment:
1. Medication Tolerance: Over time, some individuals may develop a tolerance to their antiepileptic drugs (AEDs), which can lead to a decrease in their effectiveness. This might necessitate an increase in dosage or a change in medication.

2. Seizure Type and Epilepsy Syndrome: Different types of seizures may respond differently to various medications. If your seizures are of a type that is less responsive to the medications you are taking, this could explain why you are still experiencing them.

3. Adherence to Medication: It is crucial to take medications exactly as prescribed. Even minor deviations can lead to breakthrough seizures. Ensure that you are taking your medications consistently and at the right times.

4. Triggers: Many people with epilepsy have specific triggers that can provoke seizures, such as stress, lack of sleep, alcohol consumption, or hormonal changes. Identifying and managing these triggers can be an essential part of your treatment plan.

5. Underlying Conditions: Sometimes, other medical conditions or changes in health status can affect seizure control. Regular follow-ups with your healthcare provider can help monitor any such changes.

6. Drug Interactions: If you are taking other medications for different health issues, they may interact with your AEDs, potentially reducing their effectiveness.

Regarding your current medication regimen, it appears that you are on a combination of medications, including "除癲達" (likely referring to a brand of valproate) and "妥泰膜衣錠" (which may refer to Lamotrigine). Both of these medications are commonly used to manage epilepsy, but they can have different mechanisms of action and side effects. It is essential to have regular consultations with your neurologist to evaluate the effectiveness of your current regimen and make adjustments as necessary.

If you find that your seizures continue to occur despite medication adjustments, it may be worth discussing additional treatment options with your healthcare provider. These could include:
- Additional Medications: Sometimes, adding another AED can provide better control.

- Surgical Options: In select cases where seizures are localized and resistant to medication, surgical intervention may be considered.

- Vagus Nerve Stimulation (VNS): This is a treatment option for those who do not respond well to medications.

- Lifestyle Modifications: Incorporating stress management techniques, ensuring adequate sleep, and avoiding known triggers can also help.

Lastly, it is crucial to maintain open communication with your healthcare team. They can provide personalized advice based on your medical history and current condition. Regular follow-ups and monitoring can help ensure that your treatment plan remains effective and that any necessary adjustments are made promptly. Remember, managing epilepsy is a journey, and it’s essential to stay informed and engaged in your care.

Similar Q&A

Understanding Seizure Management: When to Seek Neurological Care

Hello, doctor. Here's the situation: I had an accident in the third grade, which resulted in hemiplegia and I have epilepsy that is being managed with medication. It has been well controlled, but in the past three months, I have experienced around 10 seizures, with 8 occurri...

Dr. Lai Zhaokang reply Neurosurgery
Hello: It is recommended to consult a neurosurgeon or neurologist again, informing them of your recent recurrent episodes. Please have the doctor evaluate whether further follow-up with a CT scan or EEG is necessary, and perhaps medication adjustments may also be needed. Best wis...

Managing Seizures During Antiepileptic Drug Transition: What to Expect

I have epilepsy, with no history of brain injury or family history of the condition, and the cause is unknown. I have been treated with Depakote for nearly two years. Recently, my liver enzymes have shown an upward trend, and after discussing with my physician, I switched to Lamo...

Dr. Cai Zongzhang reply Neurology
Hello: There are many types of seizure patterns in epilepsy. It is recommended to record the frequency and types of seizures, and discuss appropriate adjustments with your physician during follow-up visits.

Understanding Epilepsy: Managing Symptoms and Seeking Solutions

Hello, Doctor. I was diagnosed with abnormal brain wave activity due to sleepwalking and other factors when I was five years old, and I started medication until middle school. I discontinued the medication in middle school as my symptoms improved. However, during my first year of...

Dr. Cai Zongzhang reply Neurology
Hello, based on your description, it seems to be symptoms of epilepsy. There may be an adjustment period during the medication process, so I recommend that you continue to communicate with your physician.

Understanding Possible Seizures: A Guide for Epilepsy Patients and Caregivers

Hello Doctor: A family member has developed acquired epilepsy (around 30 years old) and has been on antiepileptic medication for a long time. The medication has been reasonably effective, and there have been no major seizures for nearly two years. However, in the past six months,...

Dr. Cai Zongzhang reply Neurology
Hello, dear! There are various types of symptoms associated with seizures. Based on the symptoms described above, it is possible that a seizure may occur. It is advisable to inform a physician to facilitate making the most beneficial decision.