Ask The Doctor
By Dr. Russell Bailey and Dr. Nathan Fountain
We welcome Dr. Russell Bailey, pediatric epileptologist, who will be answering your questions below.
I was amazed to see a parent asking the same question that has been haunting me for months, and I was very interested in reading your answer. My daughter, 8 years old, is also taking Lamictal and we have definitely seen lack of focus in school and at home, which wasn't happening before her taking Lamictal. She gets excellent scores in all tests (reading, writing, math, etc.), but her lack of focus makes it hard for her to understand more complex assignments, e.g. complex math assignments, recall details (unless prompted) of a story, or recall all the steps in multiple step directions, etc.
I now have a follow-up question which I would love to hear your thoughts on:
The Special Education teacher at my daughter's school is now working on an IEP program for my daughter. If indeed (and my "gut feeling" has always been that this was the case) the medicine is causing the lack of focus, shouldn't we establish as the primary goal for the IEP program that she (and the teachers) learn how to live, and learn, with this lack of focus (while ACCEPTING the fact that she has a lack of focus)? Versus: fighting the lack of focus and setting as a goal that she will overcome the lack of focus and learn how to focus better.
As long as we are "sending" these chemicals to her brain with the medicine, it would seem to me that she will never be able to learn how to focus better - or do you think there is a way to "fight" those chemicals in her brain?
I very much appreciate your thoughts on this.
Thank you for this excellent question, one that I suspect many parents struggle with. Most antiseizure medications are well tolerated, and of course our goal is complete seizure control with no side effects. However, each child is different, and so we must monitor each child's response to a particular medication closely as you are doing. In this case, if the lack of focus clearly emerged after starting the Lamictal, then this could be a side effect of the medication. However, some children experience similar difficulties that accompany their epilepsy, making it difficult to tease out what is related to the medication and what is related to a child's epilepsy. Again, you ask a very relevant question, and it sounds as if you are doing what is best for her by establishing an IEP. We would suggest further that you speak with your neurologist as he or she knows the detail of your daughter's history, and may consider transitioning her to a new antiseizure medication if safe and appropriate. Thank you again for your excellent question.
My daughter is 8 yrs. old, she started having seizures almost two years ago. Her seizures usually happen only in the morning times. She is unconscious but aware of some of her surroundings during a seizure. It usually takes her 40-45 min to come to. She has the usual muscle stiffening, locked jaw, rapid eye movement. We're at a standstill right now. She's currently on Keppra daily and she's up to having 2-3 seizures a week in school. She has been to a couple neurologist here in Virginia. I'm really concerned about her care and trying to go further. If you could please help me with some sort of information about your Foundation I'd appreciate that a lot. I am trying to see where or what we should do next.
Hello my name is Lisa my mother is 67 years and developed aura related selected memory loss over the last couple of years I have temporal lobe epilepsy catamenial for the last 12 years I am now 43 it's questioned that a contraceptive injection may have triggered it. My medication lamictal controls this thankfully. The reason why I questioned the doctor regarding my mother's auras deja vue type feelings is because it's what I have experienced over the years I have also had grand mal seizures mainly in my sleep which my mother has also experienced we know of two her doctor and neurologist both said for the last two years that her auras were stress, anxiety, panic attacks as she was worried about her memory she was sent for memory tests and she was finethe only reason they eventually agreed to do an EEG was because I brought up the epilepsy being exactly like mine her tests bothawake and sleep were okay the MRI showed nothing wrong apart from the age related white cells so she was told to take an aspirin once a day nothing more was going to be done. The main seizure my father found her unconscious at the side of the bed early morning called the ambulance and it took a while to bring her round she was then confused she refused to go to the hospital when she did come round had headache and felt sick, Itook her to see the gp which she just about agreed to she has been in total denial the other one she woke up in the morning and had obviously bashed her face from what we can assume on the lamp from a grand malI took photos and showed the neurologist who still didn't agree totally but agreed to put her on lamictal which has worked no grand mal since but the occasional auras still. We saw him again about 6 months ago for a checkup but my concern was for the selective memory loss which drives her mad as you can imagine she is perfectly fine every day basis an intelligent woman I have been checking on the Internet and found lots of information one lady in particular who describes herself exactly the same as my mum I printed this information to take with us as the neurologist had said that my mums memory had nothing to do with her epilepsy I have been battling my mum and the neurologist for 12 months when I got involved after nothing was being done to help, my mum would'n accept she has epilepsy until she had a diagnosis to say this but with the tests all being okay it's taken tillappointment six months agofor him to assume it might be when my mother read the information from the lady she could then tell him how she felt he then agreed slightly apprehensive that he knew of this why had he not mentioned it? my mum doesn't drive so there is no problem with losing her license. I can't understand why the neurologist has not wanted to help really, we had an appointment on sun 30th June 2013 and she explained that she was feeling dizzy frequently had an odd headache her eyes are always heavy bit pressure on the back of her head and wanted to know if this was related to her medication he just said that it was anxiety told her to stay on same medication he has prescribed and come back in six months! I'm sure the aurashave with each one taken some of her memories and this will continue if she is not on the correct medication I'm worried that maybe she is having morejust goes prior to sleep which is the main time when she has had them but doesn't realize if she has gone straight to sleep she also has extremely vivid dreams/nightmares should we follow up on finding out more about the treatment of memory related epilepsy? my birthday was may 21st and since her last aura she doesn't remember properly what we did she explained this to the neurologist but he said again anxiety why? I'm sorry this is rather a long back ground of information but it's the only time I have questioned anything publicly and if anyone else finds it so difficult to get epilepsy even suggested from some neurologistsmygp seemed a lot more helpful and checked information on the Internet to help, can the memory come back? And are there neurologists that actually have this type of epilepsy in their knowledge, she has since got high blood pressure the last couple times been checked so is having the box on this week! thank you Lisa
Thank you for reaching out to us as we suspect there are many parents out there with similar concerns. We understand your concerns, and share them. At this point, we would recommend you contact the Epilepsy Foundation of Virginia, and request they assist you in locating a pediatric epileptologist for you to see. An epileptologist is a neurologist who specializes in treating patients with epilepsy, and more specifically a pediatric epileptologist specializes in the care of children with epilepsy. From what you have told us, your daughter's seizures have been difficult to control, and in such instances a pediatric epileptologist may be able to assist you further. You may contact EFVA by emailing or calling our regional office. Again, thank you for sharing your concerns with us.
Thank you for reaching out to us, and we share your concerns. Unfortunately, epilepsy can be difficult to diagnose as it can manifest itself in a variety of ways, and seizure types can vary greatly. We suggest you contact your local chapter of the International League Against Epilepsy who may be able to better advise you. Your mother may benefit from seeing an epileptologist who can delve further into the details of her history, and proceed with the appropriate next steps. An epileptologist is a neurologist who specializes in the treatment of patients with epilepsy. Thank you again for reaching out to us.
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
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.
Is there any evidence that the Atkins diet can stop seizures? Gina
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.
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.
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.
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 medications.
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.