Dear Nancy:
Sorry to hear about your daughter. I am assuming that she had EEG changes both with her eyes open and closed? First, various epileptologist have different values for therapeutic levels of tegratol. We at the Cleveland Clinic like the range of 8 - 12 for tegratol and we would push the dose until at least 12 or side effects to see if tegratol would be beneficial. I would assume that some decrease in seizure frequency has occurred on the tegratol. Second, assuming that the EEG changes were both with eyes open and closed, then we know that some occipital lobe epilepsies are difficult to control.
By what your telling me, your daughter seems alittle behind developmentally. This is likely, at least in part, due to her seizure activity. Was the MRI of high resolution (3D acquired)? If the MRI was a routine MRI then it might have missed subtle migrational defects. You might want to repeat the MRI if the acquistion was not optimal for neuronal migration detection.
Usually with the Waardenberg syndrome, there would be hearing loss but also eye color differences between eyes. It is usually a tuft of hair that is in a warlock type pattern. The widespread color change is not Waardenberg-like. So, I would agree with you. The hypopigmentation may just be a congenital thing but the high resolution MRI should detect any possible neuronal migration problem.
It is always difficult to say if your daughter will outgrow her epilepsy. Some children do and some don't, alot depends on the type of epilepsy and family history. If the EEG was normal with your daughter's eyes closed then I would say there is a chance that she would outgrow her epilepsy. If the EEG was abnormal regardless of eye closure then I would think that the chances are much less likely.
Let us know about the tegratol and other medications your neurologist tries and the outcome.
Sincerely,
CCF Neuro MD
Thank you for your reply. I am not sure about the MRI but the Dr. wants to have another one done in January. What is neuronal migration? As for the EEG, I am not sure about eyes open and closed (asleep?). The EEG report does say "during sleep stage II...some sharply contoured waveforms are seen over the right occipital regions." Her uncle also has severe grand mal seizures. Is it normal for it to take a long time (months?) to find the right medication to control seizures? Thank you for your input. You provided me with additional information and questions to ask at our next appointment.
Dear Nancy:
As the brain develops, neurons migrate to their proper position. When they do not migrate properly, neurons are not in their proper position and can give rise to areas of dysfunction. One of the dysfunctions is seizure activity. Unless one looks for neuronal migration abnormalities with high resolution MRI (3D acquistion) one will miss the more subtle migrational abnormalities. I do not know what contour waves are, we call epileptiform waves: sharp or spikes. These latter terms are the ones used by EEG criteria for epileptiform waves. Contours may or may not mean anything. I would ask your neurologist about this. Because if there were no epileptiform waves with your daughter's eyes closed (asleep or just closed voluntarily) then the diagnosis may change into one more favorable to ceasing as she ages.
CCF Neuro MD