Infrequent seizures

[tomattif]

Two weeks ago, I observed my fiancee's generalized seizure; it lasted for approximately two minutes. She is thirty-years-old and had been having them since she was twenty. Ten years ago, they would occur approximately every three months but now the frequency has decreased to once per twelve to eighteen months, mostly without treatment.

Last week, Convulex was prescribed, 600 mg daily, increasing to 1500 mg daily over two weeks. (This appears to be the standard course of treatment for a 50 kg. adult.) The literature which accompanied the drug indicates increasing the dosage until seizures cease. Since her symptoms occur so rarely, determining when her symptoms cease will be neither swift nor sure.

I am aware of the concept of "therapeutic levels" but I am concerned about possible side effects in a situation where the benefits are so minimal. Specifically, I am wondering if the 1500 mg maintenance level is necessary considering her infrequent attacks.

p.s.

I have incorrectly posted elsewhere on the support side of this forum that her condition was "non-epileptic." Her diagnosis was, in fact, epilepsy.

[Lama Chahine, MD]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to examine your fiancee and obtain a history, I can not tell you what the most appropriate management plan for her is. However I will try to provide you with some useful information.

I can not comment on why that specific dose of 1500 mg was recommended, however in general, a weight-based approach is used as a preliminary dose guide, and then dosing is adjusted accordingly until seizure control is achieved or until side effects are too great. Blood levels can also guide dosing: if blood levels are low, and seizures occur, increasing the dose until blood levels are within a standard range is sometimes appropriate, if excessive side effects to do not occur. Drug levels about what is considered standard should be avoided in most cases to avoid toxicity. It is true that a low seizure frequency, it is hard to determine whether the dose a person is on is un-necessarily high, but in general, if a dose is found that is effectively controlling seizures, and there are not undue side effects, that dose should be maintained, because the alternative, trying to reduce the dose, can lead to seizures which carry a high risk. Therefore, the benefits are more than minimal, though it is understandable that with such a low seizure frequency, of even less than one per year, it may seem as such. If seizure frequency can be brought down to 0, or seizure frequency significantly reduced, while avoiding medication toxicity, then a medication is considered successful, and continuing at that dose is best, with monitoring of laboratory tests to ensure no toxicity. This is however a generalization and of course it depends on the exact epilepsy diagnosis and history.

Convulex, or valproic acid, is one of the best drugs for specific types of epilepsy but has significant risks, and in women planning to have children, certain alternative antiepileptics may be more appropriate. This should be managed by an expert, ideally an epilepsy specialist (a neurologist with specialization in seizures) and someone who has experience with woman with epilepsy considering or who are pregnany. Supplementation with high doses of folic acid are very important in women with epilepsy taking antiepileptics, particularly valproic acid.

Continued followup with your neurologist is recommended.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.