Suggest Treatment For Epilepsy

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Detailed Answer:
Hello again and thank you for your question.

It is hard to give a precise answer as there is not one single drug which is the best. If there was all doctors would use that one, no doctor (good or bad) knowingly keeps the best option from his patient.

So the reason there are several drugs for epilepsy is because they have different mechanisms of acting on nerve cells. For that reason some are more appropriate in some patients some in others. Also some are more effective in partial seizures, some in grand mal ones, others in both.

Side effects also play a role, some drugs may have certain side effects in some patients, but not in others. There was a very effective drug called felbamate which now is very restricted in use because experience showed it to cause serious blood complications in some patients.

When more than one drug is used we doctors try to avoid medications which act in similar mechanism as there would be no added gain, we try to combine drugs with different mechanism of action.

I do not want to give you false expectations though, there is a percentage of patients of about 30% in which seizures are very resistant no matter what medication is tried.

So your current drugs are generally speaking very good drugs, in the sense that they act on many types of seizures, they do not act in same way can be combined, are not among the ones with the highest rate of side effects.
If they are not effective there are other many other such as valproic acid, topiramate, felbamate, zonisamide, lacosamide etc etc.

You probably have tried some of those before though, I wouldn't be surprised. In terms of new entries of the last years, a drug with novel mechanisms of action which can be tried is Perampanel.

Let me know if I can further assist you.

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Detailed Answer:
Sorry for replying a little late, been a very busy day.

A little surprised you have never tried Valproic acid as it is perhaps the most common antiepileptic.

Anyway what I said before remains. There are many antiepileptics out there, may try different ones, from traditional ones like valproic acid to new drugs like Perampanel, but there is a percentage which remain resistant though and the more you have tried without success the more likely it is unfortunately for you to be among the resistant cases. That is common in people who have changes in the brain structure, which may be left from hydrocephalus, changes already permanently established when it is corrected.

Wishing you all the best.

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Detailed Answer:
You mean a new brain hemorrhage? Or you have had a brain hemorrhage in the past?

If you have had one in the past, yes certainly, since some nerve fibers are ruptured and new connections are formed afterwards to compensate that leads to changes in the wiring of the brain, this change in brain structure predisposes to seizures. As I said any change of structure predisposes to resistant seizures.

If you mean possibly having a new hemorrhage, causing resistance, I do not think that is the case. A brain hemorrhage manifests with other symptoms apart from seizures like sudden onset headache with vomiting, weakness of the limbs on one side, altered consciousness, so it wouldn't be missed that easily. Seizures may be a presenting symptom, but rarely alone.

I hope to have been of help.

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Brief Answer:
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Detailed Answer:
I understand, so there have been two previous brain hemorrhages.

Yes they can be an issue. Now the hemorrhage itself has been absorbed, but it has left some damage behind. As I said some nerve cells and fibers were destroyed from the hemorrhage and consequently remaining fibers formed new connections to compensate. But these new connections formed are not like the previous normal ones.
It is like when you have a superficial wound, if it is a deep one it will heal, but some scar tissue is formed. This tissue is not like the previous normal skin. The same thing happens in the brain. These new connections are not a perfect replacement. But nerve cells have the characteristic that they create electrical connections apart from chemical ones like in the rest of the body. So this new imperfect connections have the predisposition to get excited more easily, inciting electrical discharges which lead to seizures. That is why having a history of brain hemorrhage predisposes you to seizures which are resistant to treatment. Hydrocephalus may have contributed as well, because its compression cause nerve cells to adapt and change their structure, forming new connections which also are more excitable. So these factors lead to your epilepsy being resistant to treatment.

I hope to have been understandable enough. Take care.

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