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Epilepsy

Suffering from epilepsy from the age of 6 mth

05/20/2009

Question:

Problem: Suffering from LEFT HEMIPLEGIA, MR & GTCS

Related Details:-

MRI OF THE BRAIN WAS PERFORMED USING SPIN ECHO T1W, TSE T2W, PD & TIRM IMAGES. SECTIONS WERE TAKEN IN AXIAL, SAGITTAL AND CORONAL PLANES. Follow up case of left sided hemiplegia. Fits, since the age of 6 months and mental retardation.

A large well defined cystic cavity is seen in the right cerebral hemisphere. It abuts the right lateral ventricle and possibly comunicates with it. The cavity occupies the right frontotemporoparietal region. Right side of the mid brain and upper pons show atrophic changes. Focal cortical subcortical white matter of the right cerebral hemisphere also shows subtle focal increase in signal intensity on TSE T2W images suggestive of gliosis. Mild pressure effect on the midline structure is noted.

Left cerebral hemsphere appears normal. left lateral ventricle appears normal. Medulla and lower pons appear normal. The cerebellar hemispheres appear normal. The paranasal sinuses show normal aeration.

IMPRESSION:-

MR findings are suggestive of porencephalic cavity possibly communicating with the right lateral ventricle with secondary gliosis of the subcortical white matter of the right cerebral hemisphere. These findings could be secondary to perinatal ischemic insult.

CURRENT MEDICATION:-

1) ZENOXA 300 :- 1-1-1 2) MECOBAL-OD :- 1-X-X 3) TRYPTOMER 10 :- X-X-1/2 Please if you can provide me with the solution of this problem. Thanks

Answer:

Please note that we cannot provide a specific treatment recommendation online. You should be seen by a health care professional for specific treatment recommendation.

Unfortunately for some people with epilepsy, currently available medications are unable to completely control seizures; in fact, for about 1 in 3 with epilepsy, seizures remain uncontrolled (this is called "medication resistant" or "refractory" epilepsy). Once an individual does not respond to trials of three different seizure medications, the chance for complete seizure control is less than 10 percent. Fortunately, there are other options available that may offer good chances for seizure control.

The first step in determining treatments for medication resistant epilepsy is to determine the epilepsy syndrome. There are two major categories of epilepsies: partial in onset and generalized in onset. In partial epilepsy, seizures begin in a specific or focal area of the brain. In the generalized epilepsies, seizures do not arise in a focal region of the brain, but involve the entire brain at seizure onset. The distinction between partial and generalized epilepsies is made by taking a complete history of the epilepsy (age on onset, types of seizures) and by using the electroencephalogram (EEG). The type of epilepsy affects the choice of medication because some seizure medications are not effective for generalized epilepsies. Thus, one of the potential reasons that an individual may continue to have seizures is the incorrect medication is chosen for the epilepsy type.

If a patient has partial epilepsy, then surgery may be an excellent treatment option and may offer up to a 60 to 90 percent chance of seizure freedom depending on the results of a comprehensive pre-surgical evaluation. The evaluation for surgery is performed at specialized epilepsy centers and basically involves pinpointing the location in the brain of seizure onset. There are multiple tests that are performed including video/EEG monitoring, several different brain imaging tests and testing of language and memory function.

Unfortunately, many patients who are good candidates for epilepsy surgery are never referred for evaluation and these individuals continue to have unnecessary seizures despite being excellent candidates for surgery. You visit the following Web site to locate the closest epilepsy center: http://www.naeclocator.org/locator/default.asp.

For more information:

Go to the Epilepsy health topic, where you can:

Response by:

David M Ficker, MD David M Ficker, MD
Associate Professor
College of Medicine
University of Cincinnati