A member presented a medical case:
Intractible epilepsy persists in a 59 year-old after surgery did not stop the seizures.
59 year-old woman started having seizures 19 years ago, with neurosurgery failing to stop them 16 years ago, and not much success with an implanted VNS 10 years ago, still searching for a good treatment.
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Patient demographics
Gender
Age
59
Ethnicity
White or Caucasian
Occupation
Retired accountant
Chief complaint or problem to solve
Diagnosed in 1996 with temporal mesial epilepsy. Tried Dilantin,phenobarbital, depakote nothing. Allergic reactions to all. Continued having complex partial siezures, sometimes 20 to 30 per day. In 1999 went to epileptologist who admitted me to EMU after 2 days siezure focus was obvious I the right temporal lobe. Had all the necessary testing and surgery was performed. Continued on with siezures only now started with tonic clinic 1 a month plus severe left sided weakness was unable to function no matter what meds were prescribed. 2005 had VNS implanted My condition deteriorated. I spent four years in a wheel chair in and out of numerous Skilled nursing facilities. Uncontrolled
Case history
1999 rt temporal lobectomy, 2005 VNS implant, 2015 VNS removal 2015 non convulsive seizures started with alter mental status.

PMH: Intractable epilepsy
Meds: Keppra, vimpat, lorazapam
Allergies:Dilantin, phenobarbital, tegretal,topi ax,lamictal,neuron tin,potiga
Other tests: Lumbar punture
Xrays: Ct's mri's
Procedures: Right temporal lobectomy, VNS, VNS removal, l
Purpose of case discussion
Diagnostic dilemma: "What are the next steps for evaluation?"
Supplemental Materials

18 doctors agree

In brief: UCLA Neurosurgery

I notice that you are in Long Beach.
I suggest you visit the UCLA Department of Neurosurgery. They are a tertiary referral center for the most difficult cases and are known worldwide for their expertise. They may be able to help you. There are new procedures, such as functional cerebral hemispherectomy that the excellent neurosurgeons there can evaluate you for. Best of luck to you.

In brief: UCLA Neurosurgery

I notice that you are in Long Beach.
I suggest you visit the UCLA Department of Neurosurgery. They are a tertiary referral center for the most difficult cases and are known worldwide for their expertise. They may be able to help you. There are new procedures, such as functional cerebral hemispherectomy that the excellent neurosurgeons there can evaluate you for. Best of luck to you.
Dr. Cornelius O'leary jr
Dr. Cornelius O'leary jr
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2 comments
Dr. Richard Zimon
TRANSCRANIAL MAGNETIC THERAPY may very well be the answer! This therapy should be available , generally in the Neurology/Epilepsy Departments at major Teaching Hospitals! Just a thought! Hope it's helpful..Dr Z
Dr. Sheldon Brownstein
Focal mapping of seizures can be done as wrell
Dr. Mary Latimer
Pediatrics - Neurology
14 doctors agree

In brief: Intractable Epilepsy

This is impossible to answer without a complete in office evaluation You should be managed in a tertiary care Epilepsy Center

In brief: Intractable Epilepsy

This is impossible to answer without a complete in office evaluation You should be managed in a tertiary care Epilepsy Center
Dr. Mary Latimer
Dr. Mary Latimer
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Dr. John Chiu
Internal Medicine - Allergy & Immunology
11 doctors agree

In brief: Go to tertiary cente

You obviously have tried many things without the result.
Have you considered going to a center like the Mayo Clinic or the NIH to see if there may be a solution or a clinical trial you can be enrolled in?

In brief: Go to tertiary cente

You obviously have tried many things without the result.
Have you considered going to a center like the Mayo Clinic or the NIH to see if there may be a solution or a clinical trial you can be enrolled in?
Dr. John Chiu
Dr. John Chiu
Thank
9 doctors agree

In brief: Intract seizures

It appears that she has a medically intractable epilepsy.
She is also failed epilepsy surgery. However, based on the information given, the seizure frequency is unknown. When was the last EMU evaluation? I would recommend further evaluation with high density EEG to look for the seizure focus.

In brief: Intract seizures

It appears that she has a medically intractable epilepsy.
She is also failed epilepsy surgery. However, based on the information given, the seizure frequency is unknown. When was the last EMU evaluation? I would recommend further evaluation with high density EEG to look for the seizure focus.
Dr. Tatyana Gitlevich
Dr. Tatyana Gitlevich
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Dr. Adam Zuber
Neurology
9 doctors agree

In brief: Uncontrolled seizure

You have a complicated problem which will require further input with detailed analysis of your medications and procedures performed.
As you know even with all procedures and medications some people may continue having seizures.New implanted neurostimulator's and medications are now available for control of seizures.Please make a virtual appointment with me to evaluate your condition thoroughly.

In brief: Uncontrolled seizure

You have a complicated problem which will require further input with detailed analysis of your medications and procedures performed.
As you know even with all procedures and medications some people may continue having seizures.New implanted neurostimulator's and medications are now available for control of seizures.Please make a virtual appointment with me to evaluate your condition thoroughly.
Dr. Adam Zuber
Dr. Adam Zuber
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1 comment
Dr. James Lin
Definitely worthwhile to explore and try...
Dr. Mark Fisher
Neurology
8 doctors agree

In brief: Not a typical case

Seizure onset at 40 is VERY unusual.
Did you have a tumor, congenital hippocampal sclerosis, AVM, what? You must be seeing an epileptologist or general neurologist who is programming your VNS (unless it's turned off). What is he/she/it/they telling you?

In brief: Not a typical case

Seizure onset at 40 is VERY unusual.
Did you have a tumor, congenital hippocampal sclerosis, AVM, what? You must be seeing an epileptologist or general neurologist who is programming your VNS (unless it's turned off). What is he/she/it/they telling you?
Dr. Mark Fisher
Dr. Mark Fisher
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Dr. Mona Khater
Family Medicine
8 doctors agree

In brief: University center

with a history of seizures that is not responding to medications I would recommend seeing a neurologist at a university center, often they do have innovative research programs that you might enroll in

In brief: University center

with a history of seizures that is not responding to medications I would recommend seeing a neurologist at a university center, often they do have innovative research programs that you might enroll in
Dr. Mona Khater
Dr. Mona Khater
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Dr. Mohamad Haykal
Neurology
8 doctors agree

In brief: Evaluation at a level 4 epilepsy center

The patient should be referred to a level 4 epilepsy center for a comprehensive evaluation.
Treatment options for drug-resistant epilepsy include epilepsy surgery, implantation of a responsive neurostimulation (RNS) device or special diets. Failure of the previous surgery to control seizures could be due to not being able to remove the seizure focus or the presence of more than one focus in the brain. Some patients may benefit from another surgical intervention. For others, RNS can be a good option. For patients who are not candidates for surgery, further medication trials can be attempted. Some patients may also benefit from specific diets such as the ketogenic or modified Atkins diet. Deep brain stimulation (DBS) is another option that could become available soon. A list of level 4 epilepsy center can be found at http://www.naec-epilepsy.org/find.htm

In brief: Evaluation at a level 4 epilepsy center

The patient should be referred to a level 4 epilepsy center for a comprehensive evaluation.
Treatment options for drug-resistant epilepsy include epilepsy surgery, implantation of a responsive neurostimulation (RNS) device or special diets. Failure of the previous surgery to control seizures could be due to not being able to remove the seizure focus or the presence of more than one focus in the brain. Some patients may benefit from another surgical intervention. For others, RNS can be a good option. For patients who are not candidates for surgery, further medication trials can be attempted. Some patients may also benefit from specific diets such as the ketogenic or modified Atkins diet. Deep brain stimulation (DBS) is another option that could become available soon. A list of level 4 epilepsy center can be found at http://www.naec-epilepsy.org/find.htm
Dr. Mohamad Haykal
Dr. Mohamad Haykal
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1 comment
Dr. Richard Zimon
Some advances in MAGNETIC therapy (TransCranial Magnetic Stimulation) may be a consideration....
Dr. Forrest Jones
Family Medicine
7 doctors agree

In brief: Neurology FU

Needs neurology update evaluation.
Would recommend seeking a specialist in a university teaching center that treats patients with refractory seizures. Hope that helps.

In brief: Neurology FU

Needs neurology update evaluation.
Would recommend seeking a specialist in a university teaching center that treats patients with refractory seizures. Hope that helps.
Dr. Forrest Jones
Dr. Forrest Jones
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Dr. Uzma Chaudhry
Internal Medicine
7 doctors agree

In brief: Medicinal marijuana

I know it is unorthodox, but I have heard that marijuana used for medicinal purposes can potentially help with seizures.
There was a story that Dr. Sanjay Gupta, MD did on CNN involving a child and how she took marijuana (not sure if ingested or smoked, or how much to give, I don't recall them specifying). You could probably do a websearch to find out more about this if interested.

In brief: Medicinal marijuana

I know it is unorthodox, but I have heard that marijuana used for medicinal purposes can potentially help with seizures.
There was a story that Dr. Sanjay Gupta, MD did on CNN involving a child and how she took marijuana (not sure if ingested or smoked, or how much to give, I don't recall them specifying). You could probably do a websearch to find out more about this if interested.
Dr. Uzma Chaudhry
Dr. Uzma Chaudhry
Thank
11 comments
Dr. Umesh Patel
I saw the story too, and it seemed that the child was having intractable seizures, which were stopped by using marijuana. To that end , they uprooted the family and moved to Colorado to obtain treatment 'legally'.
Dr. Richard Roberts
The treatment is marijuana oil, which contains no THC, butis nonetheless is banned in backward States, and can be life-changing. An excellent presentation on medicinal use of marijuana, including the oil, may be found at the website of one of the major experts in mitochondrial disease in the US, Dr. Fran Kendell, who was instrumental in getting it approved in Georgia. See http://vmpgenetics.com/
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