Referral LA area and Keppra Question

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Joined: Fri May 23, 2014 5:53 pm

by tanddsmom on Fri May 23, 2014 6:10 pm

Referral LA area and Keppra Question

My 10 year old daughter was diagnosed with epilepsy last year. She initially had blurry vision and then had instances of feelings of sudden nausea. In July 2013, she had a seizure where she lost consciousness, her whole body went rigid but there was not any convulsions. She was taken to CHOLA and put on 2ml of keppra 2x daily. She has had off and on feeling so sudden nausea still (which I understand is a seizure) her neurologist has increased her medications up each time. Recently, the seizures seemed to increase in intensity and she has had some additional symptoms (shivers), She is currently 70 pounds and is taking 11.5 ml 2x daily. Is this within normal range, and what medication would be tried next (trileptal) ? Would it be in addition to or replace the Keppra.

Also we are looking for an pediatric epilepsy expert in the Los Angeles area for a second opinion. We are currently with Kaiser. Any recommendations would be much appreciated.

Thank you
Below is the reading from her EEG
Awake: During the awake state with eyes closed, the background
consisted of a 10 Hz posterior dominant rhythm, which attenuates
appropriately with eye opening.
Sleep: With drowsiness, there is some waxing and waning of the
posterior dominant rhythm, with eventual replacement by a mixture
of beta, alpha, and theta activity. As the patient enters Stage
II of sleep, symmetrical spindles and vertex sharp waves are
present. Arousal is unremarkable.
Other abnormalities: Rare C4-P4 sharp-wave discharges occur in
Hyperventilation for 5 minutes results in no change in the
background activity. .
Photic stimulation using a step-wise increase in photic frequency
results in bilateral driving responses but no activation of
epileptiform activity.
A prolonged EKG rhythm strip revealed sinus rhythm.

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Dan Hindley
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Joined: Tue May 06, 2014 4:18 pm

by Dan Hindley on Tue May 27, 2014 3:44 pm

Re: Referral LA area and Keppra Question

Thanks for your questions.

I am based in Manchester, UK so I am sorry but I dont have any knowledge of epilepsy specialists in LA.

My usual doseage range for Keppra is between 40mg - 60mg of keppra for every kg of a child's body weight every day (this total daily dose divided into two doses morning and night). In the UK our Keppra comes as a liquid which contains 100mg per ml - this may not be the same in the USA. So for a child who weighs 30kg my normal doseage range would be between 30 x 40 = 1200mg (600mg or 6mls twice a day) and 30 x 60 = 1800mg (900mg or 9 mls twice a day). Some doctors do go higher but I dont think there is much evidence for increased benefit at higher doses in children, and the higher you go the more chance of side effects.
Assuming your daughter weighs 31kg and is having 11.5mls of the 100mg/ml Keppra liquid twice a day then she is having a total of 23mls a day (2300mg a day) which equates to 74mg/kg/day which is at the high end of dosing.
If a medication is still not working at high dose your doctor would usually review the diagnosis, possibly do further tests, and if he / she remains clear that these are a form of epileptic seizure an alternative medication would be considered. We have a host to choose from - for focal seizures (these sound most like focal seizures) in the UK we would probably try lamotrigine, carbamazepine, or oxcarbazepine depending on the circumstances and preferences of the family.
Dr Dan Hindley
Consultant Community Paediatrician

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