Encephalitis and Epilepsy: Treatment Options and Hope

Encephalitis epilepsy

I have a friend whose 18-year-old daughter was recently discharged from the hospital after a three-month stay.
The doctors diagnosed her with encephalitis, and now she is completely disoriented and only smiles foolishly.
Worse, she experiences seizures every day, with her eyes rolling back, and her left hand and left corner of her mouth twitching for one to two minutes, occurring three to four times daily.
I asked the doctor why she was discharged under these conditions, and he said they had already tried five different medications but were unable to help her.
The medications he provided me with are: Phenobarbital, Depakine, Lamictal, Sabril, and Topamax.
(He mentioned that they had previously used Dilantin and Tegretol but discontinued them because they were ineffective.) Is there any other option available? Her brain is already damaged; can she still undergo surgery? (I heard that removing a portion of the brain could improve her condition; is that true?) Who in the southern region can perform such a procedure?

Meng Ti, 30~39 year old female. Ask Date: 2003/09/25

Dr. Huang Yingzhe reply Neurology

I'm sorry to hear about your friend's daughter.
I believe she is receiving treatment at a medical center, and there are still some medications that can be tried, although they may not necessarily yield satisfactory results.
If possible, please seek further evaluation from an experienced epilepsy specialist to discuss the possibility of surgery, including which areas might be targeted and any potential side effects.
Additionally, the newly introduced vagus nerve stimulation therapy might be worth considering, but these options are specifically for managing seizures.
As for the encephalitis aspect, we can only hope for the best.

Reply Date: 2003/09/25

More Info

I'm sorry to hear about your friend's daughter and the challenges she is facing with encephalitis and epilepsy. These conditions can be incredibly complex and distressing, both for the patient and their loved ones. Let's break down the situation and explore potential treatment options and avenues for hope.

Understanding Encephalitis and Epilepsy:
Encephalitis is an inflammation of the brain, which can be caused by infections (viral, bacterial, or autoimmune) or other factors. It can lead to various neurological symptoms, including confusion, seizures, and changes in behavior. In your friend's daughter's case, the encephalitis has resulted in significant cognitive impairment and frequent seizures, which are common complications.

Epilepsy, on the other hand, is a neurological disorder characterized by recurrent seizures. The seizures can vary in type and severity, and in this case, they appear to be focal seizures, as indicated by the left-sided symptoms (left hand and mouth twitching). The management of epilepsy often involves antiepileptic medications, but sometimes, these medications do not provide adequate control, leading to ongoing seizures.

Current Treatment Options:
Your friend's daughter has been prescribed several antiepileptic medications, including Phenobarbital, Depakine (Valproate), Lamictal (Lamotrigine), Sabril (Vigabatrin), and Topamax (Topiramate). The fact that she has been on multiple medications without sufficient control of her seizures is concerning. It's not uncommon for patients with complex cases to require a combination of medications, and sometimes, finding the right regimen can take time.

1. Medication Adjustment: It may be beneficial for her to have a thorough review of her current medications by a neurologist specializing in epilepsy. Sometimes, adjusting dosages or switching to different medications can yield better results. There are also newer antiepileptic drugs available that may not have been tried yet.

2. Ketogenic Diet: Some patients with epilepsy, particularly those who do not respond well to medications, may benefit from a ketogenic diet. This high-fat, low-carbohydrate diet has been shown to reduce seizure frequency in some individuals.

3. Vagus Nerve Stimulation (VNS): This is a treatment option for patients with refractory epilepsy (seizures that do not respond to medication). A device is implanted that stimulates the vagus nerve, which can help reduce the frequency and severity of seizures.

4. Surgery: In certain cases, surgical intervention may be considered, especially if there is a specific area of the brain that is identified as the source of seizures (epileptogenic focus). However, this typically requires extensive pre-surgical evaluation, including imaging studies (like an MRI) and possibly an EEG to localize the seizure focus. The decision to proceed with surgery is complex and should be made by a specialized epilepsy surgery team.

5. Rehabilitation and Support: Given her cognitive challenges, rehabilitation services such as occupational therapy, speech therapy, and cognitive rehabilitation may be beneficial. These services can help her regain some functional abilities and improve her quality of life.

Finding Specialists:
In southern Taiwan, there are several medical centers with specialized neurology and epilepsy departments. It would be advisable for your friend to seek a second opinion from a neurologist who specializes in epilepsy or a comprehensive epilepsy center. These centers often have multidisciplinary teams that can provide a more holistic approach to treatment.

Conclusion:
While the situation is undoubtedly challenging, there are still avenues for hope and improvement. Continuous communication with healthcare providers, exploring all available treatment options, and considering specialized care can make a significant difference in managing her daughter's condition. It's essential to remain proactive and advocate for the best possible care. Your friend's family should not hesitate to seek further evaluations and explore all potential treatment avenues.

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