Is my child on the right drugs for epilepsy?
Q: My son is 7 years old and weighs 20 kg. He has an attention deficit problem. When he had his first attack of seizure the doctor prescribed: Attentrol 10 mg and Tegrital 100 mg. After an year he had his second attack and then the doctor suggested to double the dose of Tegrital 100 mg and added Lonazep 0.25 mg. Do these drugs have too many side effects?
A:Epilepsy is a very general term since there are many varieties of seizures such as (a) Generalised tonic-clonic, (b) Absence, (c) Myoclonic, (d) Tonic, (e) Atonic and (f) Focal with/without secondary generalisation. First line drug for treatment differs from one type of seizures to another. For example, the first line therapy in Generalised tonic-clonic type should be one of the four medicines i.e. carbamazepine, lamotrigine, sodium valproate or topiramate (these are all chemical names, not brand names). On the other hand if the seizure type is Myoclonic, then the first line therapy is sodium valproate or topiramate. In the absence of specific diagnosis, I am unable to comment on the rationality of drug therapy. Assuming that the child is suffering from Generalised tonic-clonic seizures then the first line therapy can be carbamazepine (sold under many brand names including Tegrital) in the correct dose i.e. 400 mg daily in divided doses (say 200 mg twice a day) for a 6 years old child. Using a lower dose may result in inadequate response and recurrence of seizures. If the seizures are not controlled by the optimum dose, then another drug can be tried and the procedure is to introduce an alternative medicine at the lowest dose and then gradually increase the dose while gradually decreasing the dose of ineffective medicine. The basic principle is to use just one effective drug that suits the patient. Two drugs are given only when a single drug fails. Clonazepam (sold as Lonazep) is not even 2nd line therapy in Generalised Tonic-Clonic seizures. It side effects include CNS disturbances including impaired alertness, depression, ataxia (difficulty in gait), respiratory depression, amnesia (loss of memory), behaviour problems, fatigue, muscle weakness, vertigo, liver disorders, blood dyscrasias and paradoxical reactions. Clonazepam should not be given to patients who suffer from agitation, nervousness, hostility, anxiety, sleep disturbances, nightmares, vivid dreams, rage, stimulation or excitement.