Question Title: new seizures & eeg

My son age 6 was diagnosed with seizure disorder originating in the occipital area of the brain 4 months ago. He also has primary immunodeficiency, secondary addisons, ashtma, poly arthritis. Orginally his seizures were visual exclusively and continous, eeg showed generalized spike and slow wave activity with slow occipital rhythm. Treated with depakote with 80% improvement.Two weeks ago he had a seizure that seemed to have paralyzed him, no jerking or uncontrolled movements, started with visual halucination then head turned left and eyes fluttering (not lids)and totally unresponsive. He was in this state for about 1 hour. In ER he had to be intubated. During Hospitalization our neurologist has increased his level of depakote and added tegretol to stop the seizures wich now begin with visual changes (halucinations and color blocks)then eyes bounce around (not lids)and he says he cant see anything clearly however progession was stopped with drugs during hospitalization. Currently he has been without a seizue for 3 days. His last eeg (since eeg taken in ER) stated that the findings continue to indicate the presence of a focal potientally epileptogenic lesion in the right occipital region with some intermittent slow activity in the right temporal region, slow occipital dominant rythm, and mild diffuse disturbance in cerebal function as well. My questions are what does this new eeg finding mean? We have not done an MRI in 10 months (wich was normal) should I push for a new one? Why would all of this change so suddenly? Does medication really control this or just untill it breaks thru again? Should we seek a second opinion since our nuerologists have not seen this type of seizure before? If so can you recommend one.

Dear RYS:

Sorry to hear about your son. Not having examined your son nor his work up thus far, it is impossible to give you exact information. Occipital lobe epilepsy is very difficult to control. We are not sure why this type of epilepsy is different from others. The EEG in the ER may represent what was happening right after the seizure event and might be different from the EEG done between seizure events. The effects seen on the later EEG still might have some changes from the prolonged seizure. It would depend on how long after the event the EEG was done. This is likely why the EEGs differ. I can not tell you if there will be another major seizure breakthrough. A couple of things that I can tell you. I would have some rectal valium or diazepam on hand in case he has a prolonged seizure, anything longer than 5 minutes would be considered prolonged. Second, I would get another opinion about how to control his seizures. Not that your neurologist is doing anything bad, but it might help to have someone who
specializes in epilepsy to give an opinion. Here at the Cleveland Clinic, the pediatric epileptologist will work with the outside neurologist in managing a patient. [You can call 1-800-CCF-CARE for an appointment, if you desire. But any good epileptiologist would be fine]. Whether to get another MRI is questionable. The last MRI is recent and likely nothing will have changed. However, this is something you should discuss with your neurologist, since he/she would know your son best. Let us know if we can be of further help.

Sincerely,

CCF Neuro[P] MD

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