A
9 yrs old girl with history of single nocturnal generalized and right partial
seizures at age of 3 yrs, controlled on Depakine. She was seizure-free for about
2 yrs. Depakine was discontinued gradually. Then started again in 2006 to get
right partial seizures again for brief period (minutes) about once every 1-2
months at awakening from sleep. Depekane restarted with good control but noticed
to gain weight (now 43 Kg), so stopped and replaced by Tegretol, but again
stopped due to rash. Currently from March 2007 Lamictal started, now 125 mg bd.
Noticed to have worsening of the attacks on increasing dose of Lamictal; more
frequent (1-2 per week), longer duration (30-60 min.) and associated with a form
of posturing of the right hand (sort of fist) for about 30 minutes. No LOC.
Attacks always at awakening with pain in the calf area.
EEG
several times always abnormal with left focal sharp activity (frontotemporal
region), 2 attacks were seen during ambulatory 38 hours long-term EEG recording.
MRI reported normal. Her school performance is getting affected because of these
attacks; socially the girl is well adjusted at home and good student. We thought
these are unusual partial seizures which needs further adjustment of
treatment/modification or most likely Lamictal-induced movements or Lamictal-aggravated
seizures. The plan to stop Lamictal and replace it by either LEV or TPM
anticonvulsant.
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(c) 2007 M.H.Rivner
Date Modified 12/7/2007