post surgery seizure

[ManjuB]

Dear Sirs,

My husband was dignosed and operated for left temporal astrocytoma grade 2 in May 2001. Since then he is taking 300 mg of phenytoin. In between last three and half years he had very small seizures which lasted for fractions of seconds. But once in Sep 2004 and again in January 2005 he had a typical epilepsy fit. His MRI showed no significant tumors. There is one small cavity according to our doctor which might have formed as result of radiotherapy and according to him it is lying as it is for quite some time. Doctor believes these fits now is mainly because of irreular absorption of medicine. Please comment and show us the way. I have a small son and I desparately look forward for his life. Is this line of treatment fine or should we go for second consulttaion.

Thanks
MAnju Bansal

[CCF-Neuro-M.D.-CS]

The seizures caused by a tumor are not from the tumor itself but from the immediate surrounding brain tissue. Even if the tumor is removed there is a chance of continueing seizures. The trauma from surgery or radiation itself to brain tissue in itself has a small risk of continuing seizures. I cannot comment on whether there is evidence that the tumor has recurred without knowing your case or MRI scan

There are several other reasons for continued seizures - if you miss medication doses, some medication interact with the phenytoin and reduce the level, or you may require a larger dose for your weight. Your doctor should be able to tell you. Phenytoin concentrations are easily measured in the blood and can tell if there are absorption problems. Sometimes seizures become resistant to a medication for reasons we do not know - in that case there are many other seizure medications that can be tried that may be effective.
Seizures by themselves, if well controlled, should not limit your lifespan
Good luck

[ManjuB]

Thanks very much for the hope and guidance you gave.

kindly suggest me names of some good neurosurgeons who speecialise in this area  specifically along with the fee structure. Please also inform me about any alternative form of medicine for this purpose.

thanks once agin.

M.  Bansal