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Dr. Bob
Dr. Bob, Neurologist (MD)
Category: Neurology
Satisfied Customers: 5330
Experience:  Neurology & Int Medicine (US Trained): 20 yrs experience
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My husband was diagnosed with epilepsy about 12 years ago.

Resolved Question:

My husband was diagnosed with epilepsy about 12 years ago. He had 3 tonic-clonic seizures and then once on medication (Topiramate) was seizure free for 10 years. Breakthrough seizures started about 2 years ago - which I did not witness. His medication was increased, then increased again. During this period the seizures he had were (I don't know their name) at first 'absent' and he complained of headaches (we later realised this was an indication of a seizure), and latterly 'automoton', where he would go walk about and know what he was doing (he would also have an explanation). Finally, after he lost his job, his medication was changed to Leviteracetum and he was weaned off the Topiramate. This new regime started in November 2013. He had a seizure in the jobcentre when he went to register at beginning of December, then a further 'walkabout' on Boxing Day. He was then fine, until April, when I believe he had two - an 'absent-like' seizure' which resulted in a job offer being withdrawn; and an 'automoton', which only I witnessed. This was a particularly stressful time as he was applying for jobs and having to take interview tests.

However, my main concern now is that he has had two tonic-clonic seizures at home, at around 7.45pm in the last month. He is clearly a lot better, brighter mentally and his memory is much improved, but the fact is his seizures have returned to their original state. Should we just accept that this is how it will be now? In the meantime, he is not considered unfit for work according to Government rules, but these seizures take us by surprise and surely make it more difficult for him to hold down a permanent job.

Should he tell his doctor, and get a review of his medication?
Submitted: 3 years ago.
Category: Neurology
Expert:  Dr. Bob replied 3 years ago.

Dr. Bob :

Hello. Breakthrough seizures represent a worsening on one's condition, and should be worked up. Has he had an MRI and EEG recently?

Customer:

Yes, he saw his neurologist last year after his employer had suspended him on full pay. This would be a year ago. There were no actual witness statements on what had happened - his employer had not provided them. I had not seen them. This was when his medication (Topiramate) was increased to the maximum dosage. By November, it was obvious that this medication no longer worked as he was still having the 'walkabout' seizures.

Customer:

In November, he was prescribed the Leviteracetum. As I said in my previous post, mentally he is much clearer, and more positive in attitude, and since the new year he has seemed fine. Do you think we should insist on a further review of the medication level, because of these two recent ones?

Dr. Bob :

It sounds like he is doing much better on the Keppra. It is an excellent anti-seizure medication, and he should stay on it.

Dr. Bob :

If he is still having some breakthrough seizure activity, he may need to have his dose increased or a small dose of a second anti-seizure medication added.

Dr. Bob :

Before this happens, however, he should have his situation reevaluated completely, including any other meds or supplements he might be taking, any recent changes in his weight, diet, exercise routine, or even stress levels.

Dr. Bob :

If a cause can be found for these recent "walkabouts", a minor intervention or change might be all that is needed.

Customer:

It is quite stressful trying to find employment; and he is not as active as he used to be. His hobby is golf, but having to rely on people to drive you about... well he is not a good passenger.

Customer:

He has put on a bit of weight, so I will try to get him to get out and about a bit, and speak to someone about the medicine. He doesn't take any supplements.

Customer:

Thank you for your help.

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