Question Title: High dosage medications for seizures

Forum: Neurology Forum
Topic: Autism

Posted by CCF Neurology LG on March 04, 1998 at 22:19:35:

In Reply to: High dosage medications for seizures posted by Donna E. on March 04, 1998 at 17:21:05:

: The situation is as follows:
A sixteen year old person, who resides in one of our agency group homes has
some seizure activity as demonstrated by falling. This person may lean
to one side as if losing her balance or collapsing (atonic drop seizures?).
There are no convulsions or any loss of consciousness. The young lady
was diagnosed with autism as a young child. About five years ago the
neurologist gave her a diagnosis of Rett's Syndrome. There has not been
the typical deterioration seen with Rett's over the past years.

This person was started on Tegretol 300 mg./day which stopped the
falling behaviors. The blood level was only 3.1. The neurologist then
increased the Tegretol to 900 mg./day. The blood level then rose to
6.5, and the person appeared to be seizure-free, but was lethargic and
drowsy. The doctor then raised. the dosage to 1200 mg.,day. The level
went up to 7.8. The neurologist stated that he wanted the levels to be
between 10 and 12. The side effects of the medication increased with
the dosage increase. The child gained 20 pounds in a very short time,
refused all activity, even the things usually so much in the past.

When the neurologist was asked the reason for the very high dosage of the
medication, he stated that he wanted to "cure the seizures" so that
seizure medications would not have to be taken throughout life;
the aim was to normalize the EEGs. At present, due to side effects, the
neurologist is going to lower the dosage of Tegretol to 600 mg./day and
start Topamax and gradually raise it to 600 mg./day, aiming for a level
of 10-12.

My question--can high dosages of seizure medications cure a seizure
disorder? Does anyone have information regarding the use of high
dosages of anticonvulsant medications to normalize EEGs? Any
information you can share with me will be greatly appreciated.

Donna

Dear Donna,

A seizure is a paroxysmal event that is manifested due to an underlying disorder. Anticonvulsant medications (seizure meds) cannot "cure" epilepsy/seizures but decrease or eliminate the frequency of the seizures. The drug "levels" are used as guidelines to moniter the medications. Ideally, the drugs should be increased or decreased to obtain adequate seizure control and to avoid side effects. It sound as if the patients may have been acheiving adequate seizure control at 300mg a day. It is difficult to comment on the EEG without knowing the underlying abnormalities; there are certain epileptogenic potential that may be reduced with adequate seizure control. Also, in Retts syndrome there are some EEG changes that occur (slowing and disorganization) as the disease progresses. I would talk to the patients doctor regarding the optimum dose. Good Luck.

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