Re: Incontinence in Complex Partial Seizures?

Posted By Dee on August 08, 1999 at 09:04:44
I recently posted some questions concerning epilepsy in my six year old son.  Again, thank you for your response.  However, there have been recent developments that has me puzzled.  My son's doctor, or nurse I should say, hasn't been able to provide a satisfactory explanation other than just to relay the doctor's messages.  I really need to understand what's going on.  My son was diagnosed with complex partial seizures and simple partial seizures.  They are in the occipital area, but a little more on the right side of the brain.  They recorded through video EEG constant spikes day and night, with the worst occurring at night - hence the hallucinations when he wakes up during the night.  During the day he has many staring spells.  He also has signs of Tourettes.  He has many motor movements, but mostly the arms and leg and  head, but not the face.  He occasionally has vocal tics, but over the past four months I've only heard them on three separate days.  His doctor observed these symptoms and said a diagnosis of Tourettes can't be established until he's had this for a year, which I do understand.  He also said he's never had a child with both tics and seizures and this may be very difficult to treat.  My son was started on Tegretol July 8th and the current daily divided dose is 300 mg.  Since he started on this medication, there has been NO change.  Everything has remained the same, but with one negative change - he's become very incontinent.  It started with just a little loss of  his bladder, but has now progressed to losing the whole contents.  He is never aware of it - just the family.  He was watching my daughter play a game on the computer and he was standing there not aware that he was losing the contents of his bladder.  When the Tegretol was increased to 300 mg from 200 mg at that time, the only change I noticed was the decrease of incontinence, but it did not stop it completely.  He's been on the increased dose for two weeks now and the frequency of bladder loss is increasing again.  He's now starting to wet the bed at night.  He starts school in a few days and my heart goes out to him if he should lose control in front of the other children.  I've stayed in communication with the doctor's office, but the response was to order the first blood test - CBC, AST, ALT and Tegretol level.  We are awaiting those results.  His tics are so bad that he can't walk without his gait being disturbed by the movement of his legs.  His head jerks up and down and side to side and his speech is now constant stuttering.  What's happened to my little boy?  I haven't talked to him about any of this and play it cool around him.  When he loses his bladder I just help him clean up and say, "Oop, guess you had an accident.  Let's go clean up." And leave it at that.  Please tell me what I should do.  I didn't know there could be bladder problems with these kind of seizures, or is it related to the medication.  It's never made him sleepy or anything.  It's like he's taken nothing at all.  I appreciate your input.
Dee

[CCF Neuro[P] MD RPS]

Posted By CCF Neuro[P] MD, RPS on August 08, 1999 at 15:00:44
Dear Dee:
Sorry that your son is having so many problems.  I remember your posting and going back over our patient data base I came across several children with tourette's and epilepsy.  We have about 20 in our practice at CCF.
I would wait for the levels of tegratol to come back.  As you know, it inducing its own metabolism so it take awhile for a therapeutic level to become steady-state.  I would push it near the 12 level to make sure it has any effect and if not would add another medication.  
Tics can be difficult to control and medication is sometimes required.  We will treat if the child is embarrassed by them.  The medication treats the tics but not the disease.
Incontinence is alittle unusual in complex seizures located in the occipital lobe.  If there is generalization then one would see incontinence.  With multiple breakthroughs a day, it does seem that medication will have to be evaluated for effectiveness.  Wait for the level and then return with questions about dosing and added medications (or switch).  
If you are feeling that things are not going the way that they should, ie communication and results you may want a second opinion from an epilepsy specialist.
I hope that I have helped you alittle.
Sincerely,
CCF Neuro MD










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