Nutritional Support and Medication Management for Epilepsy in Children

Nutrition and Medication in Epilepsy

Hello, my son suffered from hypoxic-ischemic encephalopathy due to oxygen deprivation at birth, accompanied by seizures, and underwent hypothermia treatment.
Initially, he only experienced minor seizures just before falling asleep, which occurred every few seconds and resembled a startle reflex.
However, these episodes began to occur during the day as well, leading to the addition of Levetiracetam (Keppra) to his treatment regimen.
Recently, he experienced his first major seizure since birth, characterized by loss of consciousness, left-hand twitching, and nystagmus.
A subsequent video recording confirmed that the previous minor seizures before sleep did not exhibit epileptiform activity, indicating that the recent major seizure is indeed epilepsy.
Should we consider discontinuing Levetiracetam? If the doctor stated that it is not epilepsy, why has there been a reduction in daytime and pre-sleep twitching since starting the medication? He is currently nearly two years old (9.5 kg) and is regularly taking Clonazepam (1.3 cc twice daily) and Levetiracetam (half a tablet in the morning and one tablet in the evening) along with vitamin B6.
We are troubled by his ongoing issues with poor appetite, significant gastrointestinal dysmotility, and severe bloating, as well as difficulties with attention.
Are there alternative methods to improve his condition aside from changing medications? What additional nutrients should be supplemented for a patient with epilepsy to stabilize his condition? Thank you.

Yv, 30~39 year old female. Ask Date: 2021/07/15

Dr. Cai Zongzhang reply Neurology

Hello! Exaggerated startle reflex is a common sequela of hypoxic brain injury, which can be triggered by any stimuli (e.g., sound, touch).
If the symptoms are mild, medication may not be necessary; if medication is required, low doses can be used to alleviate symptoms.
For generalized seizures, antiepileptic drugs are typically used, and the dosage can be adjusted based on the frequency of seizures.
Antiepileptic medications also serve as anxiolytics and can help alleviate both types of symptoms.

Reply Date: 2021/07/15

More Info

Managing epilepsy in children, especially those with a history of hypoxic-ischemic injury, requires a comprehensive approach that includes both medication management and nutritional support. Your concerns about your son's recent seizure activity and his overall health are valid and warrant careful consideration.

Medication Management
In children with epilepsy, the choice of antiepileptic drugs (AEDs) is crucial. The medications you mentioned, such as Levetiracetam (悠閒) and Clobazam (赦癲易), are commonly used to manage seizures. However, the effectiveness of these medications can vary from child to child. It is essential to work closely with a pediatric neurologist to monitor your son's seizure activity and adjust medications as necessary.
Given that your son experienced a significant seizure (a generalized tonic-clonic seizure) and has a history of other seizure-like activities, it is important to evaluate whether the current medication regimen is adequate. If the neurologist has indicated that the earlier movements were not epileptic in nature, it may be worth discussing the rationale for continuing Clobazam, especially if it appears to reduce the frequency of other movements.

Nutritional Support
Nutrition plays a vital role in the management of epilepsy. Children with epilepsy may have specific nutritional needs, especially if they are on AEDs, which can sometimes affect appetite and gastrointestinal function. Here are some nutritional considerations:
1. Balanced Diet: Ensure that your son is receiving a well-balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats. This can help support overall health and may improve seizure control.

2. Ketogenic Diet: Some children with epilepsy benefit from a ketogenic diet, which is high in fats and low in carbohydrates. This diet has been shown to reduce seizure frequency in some cases. However, it should only be undertaken under the supervision of a healthcare professional.

3. Hydration: Ensure your child is well-hydrated, as dehydration can sometimes trigger seizures.

4. Supplements: Certain vitamins and minerals may be beneficial for children with epilepsy. For example, magnesium and vitamin B6 have been suggested to support neurological health. However, it is crucial to consult with a healthcare provider before starting any supplements.

5. Addressing Gastrointestinal Issues: Since you mentioned your son has gastrointestinal issues, it may be helpful to consult a pediatric gastroenterologist. Addressing issues like constipation or bloating can improve overall well-being and appetite.

Behavioral and Attention Issues
The attention difficulties and irritability you mentioned could be related to several factors, including the medications, the underlying neurological condition, or even nutritional deficiencies. Behavioral therapy or occupational therapy may be beneficial in addressing these concerns.

Conclusion
In summary, managing your son's epilepsy involves a multifaceted approach that includes careful monitoring and adjustment of medications, nutritional support, and addressing any behavioral or gastrointestinal issues. It is essential to maintain open communication with your healthcare team, including a pediatric neurologist and possibly a nutritionist, to tailor a plan that meets your son's specific needs. Regular follow-ups and adjustments based on his response to treatment will be key in managing his condition effectively.

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