Seizure medication dosage

Hi my daughter 15 years old, 88 lbs is on valproate sodium 10 mL twice daily and rivotril 0.5 mg two tabs daily. What is the optimum dosage for her as she still continues with sudden mood swings from normal to suddenly laughing or crying, which as per neurosurgeon are nothing but small scale seizures. Thanks

[Arti Sharma, M.D.]

Hello,
Usually valproate is initiated at a dosage of 10 to 15 mg/kg/day. The dose is increased gradually by 5 to 10 mg/kg/week to achieve optimal clinical response. Usually optimal clinical response is achieved at daily doses below 60 mg/kg/day. If there is no satisfactory clinical response determination of plasma levels to check whether they are in therapeutic range (50 to 100 µg/mL) or not should be done. It is usually not recommended to take valproate at doses above 60 mg/kg/day .Emotional lability is one of the side effects of valproate.It is best to have  a frank discussion with your doctor and get your doubts clarified. Do keep us posted.
Take care and regards!