500 Ray C. Hunt Drive First Floor
DoctorWe welcome Dr. Russell Bailey, pediatric neurologist, who will be answering your questions
your question about epilepsy.
The questions below have been
answered by epileptologist Dr. Nathan
B. Fountain, Director of the FED Comprehensive Epilepsy
Program at the University of Virginia in Charlottesville. He is also the President of the Professional Advisory Board.
My son is currently
taking Lamictal for his seizures. My wife and I were wondering if his
often lack of focus in school might be due to the medicine. Thank you
Al Ten Midlothian, Va
Seizure medications, and
especially Lamictal, do not usually affect thinking. Most children
tolerate them very well without any affect on their school work,
personality, memory or thinking. However, some children do have
problems either because the particular medication does not agree with
them or the dose is too high. All seizure medications, including
Lamictal, can occasionally cause a loss of focus through their subtle
effects on thinking. They can cause inattention, drowsiness, memory
difficulties or difficulty concentrating. There is no simple way to
figure out whether the medication is contributing to his lack of focus.
If he was a good student and focused until Lamictal was started, then
it is more likely that it is the drug. If he had lack of focus prior to
starting the medication then it is probably not the medication. A
common problem is that the medication started when the seizures
started. Thus, you don't know if the change is from the medication, the
affects of the seizures on the brain (which is usually minimal) or the
social of psychological effects of having seizures. This is best sorted
out with your neurologist.
In your opinion,
what future research could be done to find out what causes the neurons
to seize? If only we knew what made the neurons start doing this… Do
some of these studies pose ethical problems? Submitted by Laurie,
mother of a ten year old girl with partial seizures with secondary
generalization, currently controlled by medication.
This insightful question has
been poised by all who study epilepsy. There are many researchers
studying this exact problem. We actually know quite a bit about what
happens when neurons seize based on contemporary neuroscience research.
The main problem now is figuring out why the neuron seizes at one
moment and not another. Nevertheless, there are a few "designer drugs"
available now that were developed to interfere with the processes that
cause seizures, such as tiagabine (Gabitril), and pregabalin (Lyrica).
Fortunately, this research does not commonly pose ethical problems
because there are many animal models of seizures. Clinical research
(using humans) is usually done as part of the care of patients with
epilepsy. For example, we currently are studying 3 new drugs and 2 new
devices for epilepsy at UVA. Many patients volunteer for the studies
because it has some chance of helping them and because the results
allow us to help others.
Is there any
evidence that the Atkins diet can stop seizures? Gina
The Atkins diet has not been
studied systematically. However, in a Johns Hopkins open-label study of
20 children put on the Atkins diet about 2/3 had a 50% reduction in
seizure frequency. It has a risk of high fat content and therefore a
high cholesterol content (it significantly elevated the cholesterol in
the above noted study). The health risks for children who may need to
remain on it for a long time are not known but seem substantial. On the
other hand, it is simple to administer and should be considered in
people who don't respond to medications. The ketogenic diet is
effective in reducing the frequency of seizures, but has not been
studied in a way that allows it to be compared with medications. It is
somewhat difficult for parents and physicians to administer. However,
it is also a good option for people with epilepsy who do not respond to
Are there any
"seizure belts" like there are "kidney stone belts?" For example, the
southeast has a higher rate of kidney stones than other places.
Submitted by Laurie Kelly, mom of 10 year old girl with epilepsy.
No. Epilepsy is evenly
distributed around the country. However, the incidence is higher in
developing countries due to higher rates of brain infections and
trauma. Overall, about 10% of people will have a seizure at some time
in their life. Only 3% will have recurrent seizures and thus epilepsy.
Finally, it remits in about 2/3 of people, so that only about 1% of the
US population has epilepsy at any one moment in time.
What about Las Vegas?
can epilepsy move from one side to the other?
How serious is a high prolactin level?
Helping daughter be independent post-diagnosis
drugs hamper child development?
about Las Vegas?
need a sponsor like yours here in Las Vegas.. How and who helped you?
We have nobody and we are despair. Thank You GOD Bless YOU!
Answer: (EFVA) Dania Alvarez
has a support group in Las Vegas. She can be contacted at
times my son goes into a rage. Is that a seizure and how can I control
Answer: (Dr. Strunc) Emotional
lability, rage attacks, and changes in personality can all be
manifestations of a seizure. These rages that occur could also be the
after effects, that is the post-ictal (post seizure) changes. History
is everything, almost, when diagnosing seizures. What occurs before the
rage episode? Are these triggered by his being upset or angry? How long
do they last? Can you interrupt them, or stop him during one of these
attacks? Most seizures are not provoked, cannot be interrupted, and are
often followed by a period of fatigue. If this seems to be the case for
your son, they may well be seizures. I would recommend that you talk
with your son's neurologist about these episodes. One way to get to the
bottom of this is to have your son admitted to a video-eeg unit. A
prolonged eeg that captures one of his spells would be very helpful in
sorting out seizures as a possible cause of his rage attacks. If they
are seizures, medication is likely to help control them. Good luck with
can epilepsy move from one side to the other?
have a 5 year old who has been having seizures since he was 10 months
old. They have tried just about every medication and nothing seems to
keep the seizures under control. He currently is on 60 mg a day of
Phenobarb, 250 mg a day of Topomax and 100 mg a day of Lamactal. Once
he starts running a temp of 99 he always breaks through his meds. When
he first started having seizures all tests indicated that the seizures
were coming from the left side of his brain. In the past couple of
months we have doing LTM to see if he is a candidate for the VNS or
brain surgery. The last test was 2 weeks ago and that was the ictal
scept. The epilepsy team said without looking at the all the test
results together that the 75% of the seizures were now coming from the
right side of his brain and the other 25% they don't know where they
are coming from and the left shows abnormalities. They said it now
looks like he is having bilateral seizures. I still haven't heard back
from the epilepsy team but my questions are these. Why would the
seizures move to a different side of the brain and if they are
bilateral what would be the chance of them removing the part that is
showing more seizure activity? He has tonic clonic generaliazed
seizures. He desats when he seizes and what used to take only a couple
of days to get the seizures back under control in now taking pretty
close to 2 weeks.
Answer: (Dr. Strunc): I can
understand your frustration and questions. How can epilepsy change from
one side to the other, or both? How come seizures get worse over time,
and are harder to control? Your questions are excellent, but the
answers are vague at best. We do not know why epilepsy evolves over
time in some patients, while in others it is simply outgrown. Your son
has had excellent care and an extremely thorough evaluation by the text
of your questions. Epilepsy surgery is an option that can be
miraculous, in the right patient. Success in "cure" for temporal lobe
epilepsy patients can be as high as 70-90%. This success is not equaled
in any other group. Non-lesional epilepsy, that is when we cannot
actually see the brain abnormality causing seizures, is remarkably less
successful. When you have multifocal epilepsy, seizures originating
from multiple areas of the brain, the odds are very much against
surgical success. This does not mean your son is not a surgical
candidate. That decision must be made with the team you are working
with, and you. I would encourage you to discuss this with your team,
and to get a best estimate from them regarding the possibility of
significant improvement with surgery. If he is not a candidate for
surgery, the vagal nerve stimulator is an option. This device can
dramatically improve seizure control in patients. Good luck with your
serious is a high prolactin level?
daughter was a patient of Dr. Driefus' many years ago when she just
turned 12 (started her periods) and was diagnosed with epilepsy. She is
now grown and has health insurance with a large well known HMO. HMO has
run tests and her Prolactin level is high. Her current doctors at the
HMO act like they do not know what to do or they don't know what
Prolactin is, and they are not discussing it or treating it or advising
her. My question is how serious is a high Prolactin level and how will
it impact on your body and life style? How should it be treated, is my
daughter in danger? Will you direct me to any information that is
Answer: (Dr. Strunc) This is a
question for a child endocrinologist. Prolactin is a hormone secreted
by the anterior pituitary. Elevated prolactin levels can be seen
acutely after a seizure, and can be used to determine if someone has
had a seizure. Chronically elevated levels of prolactin would cause
concern about a pituitary tumor known as a pituitary adenoma. The
symptoms could be headaches, visual changes, hormonal changes, or
precocious puberty. This needs to be reviewed by a pediatric
endocrinologist and I would have your HMO doctor set up a referral to
see one. Prolactin levels also vary by sex, and age. This needs to be
factored in when looking at the prolactin level. Regardless, I cannot
give you guidance beyond suggesting your daughter sees the proper
specialist. I am unaware of any danger to health posed by elevated
are the results from recent studies with the Atkins diet for epilepsy?
Answer: (Dr. Strunc) The
results so far are encouraging, but mixed. A number of case reports
have demonstrated a statistically significant reduction in seizures
while on the Atkins diet. This therapy is modeled on the ketogenic
diet, whereby a high fat, low carbohydrate diet causes the body to make
and use ketones for energy. The brain can only use ketones and glucose
for energy. How this causes seizures to be controlled, or lessened is
still not understood. There are a number of studies that are ongoing to
look specifically at your question. Can a "modified" ketogenic diet
help control epilepsy? Your neurologist can help sort out where we are
with this research. For now, the jury is out, but it looks like some
patients may benefit from this treatment option. You can review one
article that looked at the diet in several patients in the journal
Neurology 2003:61: pages 1789-1791. I hope for the best for you and
daughter be independent post-diagnosis
daughter is 9; she was diagnosed at 7. She is very moody and her
short-term memory is really bad. She is taking Topamax. She is very
clingy every since she was diagnosed with epilepsy. How can I get her
to be not so clingy? I love her very much, but I also want her to have
her independence. Thank you and God bless you and your work.
Answer: (Dr. Strunc) Changes
in mood, attention, ability to sit in school and learn: all of these
are common in children diagnosed with epilepsy. The medications we use,
by their very nature, affect how brains work. The goal of all pediatric
neurologists is to have their epilepsy patients seizure free, and side
effect free. Time often mellows the side effects, but the appropriate
dose, and timing can also be critical for patients. Each medication
that is available has common as well as rare side effects. I would
encourage you to read up on each, and discuss the options with your
child neurologist. Communication can often be sacrificed in the hectic,
fast-paced office visit. It is important to address the side effects
you see, as well as the benefits, with your daughter's doctor.
Remember, each child is different, and unique. Some children are
clingy, regardless. Some kids are hyperactive, tired, easily angered,
sad, etc. You need to try to sort out medication effects, from the
person taking the medicine. If you find "clingy" is your daughter on
medication, and she is not when off the medication, well, maybe another
medication would be better. Lastly, there is no free lunch. Any time we
change medication for our patients, we risk failure due to side
effects, toxicity, or failure to stop seizures. Make these decisions
carefully in concert with a neurologist you trust. I wish you the best
of luck and God bless your family.
drugs hamper child development?
anti seizure drug hamper development? My 4-year-old, diagnosed in
infancy, is on Depakote and seems slow.
Answer: (Dr. Strunc): There is
no good evidence that the medications we use actually cause children to
have developmental delays. Many children on medication are sedated,
slow, or just moody. The medications we use can all cause this. I have
had many kids come off of medication, and immediately "wake up" as if
from a dream. Parents often see what we do not, the less obvious
dulling of a young child's personality. While the medications do not
cause delays, they can cause these changes. If a child is sleepy,
tired, slow to respond, cranky, etc. how well will they learn in
school? Good questions, with pretty weak answers. We are left with the
goal we all have: no seizures, and no side effects. Depakote is a very
effective medicine against seizures. Like all the medications we use,
it has side effects. If your child seems slow on depakote, perhaps
another drug would be better. This is the dilemma for all the
medications. None of the medications is perfect. What you need is the
right medication for your child. That needs to be decided by you, with
your child neurologist. Talk with her/him about the options you have,
the side effects of each option, and go from there. I wish you the best
of luck with your child.