Consultation

Good evening iwant to consult neurologist about my son he have epeleptic fits uncontrolled he is take two medicine (tegretool CR 200MG b.i.d and topamox 150 mg b.i.d).some neurologist advice to increase the dose of topaox and other advice to add new medicine(lamictal or revotril).iam ask for your help and oponion to face this proplem. note: medical report attached.MEDICAL REPORT Name : Mohammed Samer Al-Shorman Sex : Male Age : 11 1/2 y.o. Nationality : Jordanian Wt : 42 kg. The above-named patient is known to have Brain Atrophy since he was 8 months old. The boy suffered Tonic-Clonic Sizures for which he was given Tegretol Syrup for two years and Rivotril Syrup for 6 months and there were no fits during the period of treatment. Lately, on April 30, 2005, he started to have minor seizures noticed by parents as disturbed sensorium, eye elevation (not common), incomprehensive words, inability to recognize place and time and confusion. He was put on Tegretol tablets 200mg B.I.D. In July 2005, he started to have fits again. The Neurologist in Jordan advised to increase Tegretol CR dose to 300mg AM and 200mg PM,but fits were not controlled. Then, the Neurologist advised to further increase Tegretol dose to reach 300mg BID with no further control of fits. Topamax was added and titrated from 25mg OD THEN 25mg BID and still fits were not controlled. He is taking Tegretol 300mg BID and Topamax150mg AM and150mg PM. with no control of fits. Tegretol serum level was checked and found to be7.4g/dl. E.E.G. was abnormal and showed localized disturbance of cerebral activity over the left hemisphere in the form of slowing and active discharge mainly over the left central parietooccipital region. This form of tracing reflects structural pathology as well as epileptic focus over the left hemisphere. Clinical correlation and MRI study is recommended. Please for your kind advice and recommendation about further Management.