system
Suggest treatment for seizure along with anger and hallucinations
human
Hi, My brother is suffering from seizure disorder (from birth) with MR and OCD. He gets frequent outbursts of anger and hallucinations. Born by LSCS, third in no. (3rd issue) was alright for 2 days after birth c/c with refusal of feeds and convulsions on 27th Jan. 1996. Patient was shifted to Neonatal Pediatric Department of Sher-I-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, Kashmir, India where he was treated for Neonatal Sepsis, received plasma transfusion. At the same time, he developed slight squint eyes (Nystagmus) which progressively increased till date. He was discharged after one month and was put on sodium valporate. Patient develops convulsions on and off till date. The duration and intensity of convulsions varies from time to time which extends from some minutes to hours with the result, he becomes incontinent. There is an H/o vomiting and fever. Patient remained under pediatric observation till date. In the meanwhile, he got admitted in the school at the age of 3½ yrs but his schooling got disturbed with his ill health (seizure/convulsions) so, he remained off from school. Initially he was cooperative and doing well, but he left school as he was pressurized by teachers to compete with other normal students. From last 2-3 yrs, he developed severe behavioral disturbances, anger, trying to fulfill his demands at any cost. In Nov.2009, he got admission in Composite Regional Centre (CRC) Bemina, Sgr. for getting special education but lost interest after finding himself isolated among children with severe abnormalities like Down syndrome etc. Then he got admission in Voluntary Medicare School for special education but due to his impatient and aggressive behaviour, he remained off from school most of the times. As for his behavioural change, patient went for psychiatric consultation to AIIMS, New Delhi and was advised specialised treatment (psychiatry unit dept. with behavioural intervention).                He gets seizures very often but from June 2014, he has not got a major attack as his Neurologist increased dosage of Tegretal CR to 300 mg BD. However, he complains some light formation (black out) in his eyes and starts uttering unusual words and then after taking some rest becomes OK. What could it be and what is possible remedy for this. Presently, he has developed unusual OCD that is to say he goes wash room very often and washes his hands & feet by counting upto 500. He does not open the doors with his hands but feet and with time he has become very hygiene conscious. He remains very disturbed. Can you please suggest some remedial measures to improve his condition. Regard s Aisha
gpt
Hello thanks for asking from HCM Thanks for providing detailed history. I can understand your problem. You brother of 18 years have mental retardation, seizure disorder since birth, developed after neonatal sepsis. He was clinically better but has developed aggressive behaviour since last 2-3 years. Currently he is on Carbamazepine 600 per day. Now he has developed Obsessive compulsive symptoms with compulsive hand washing and these are severe to such degree that he has even stopped to close the doors. These are due to severe OC symptoms.As per my opinion there is need to add some good anti anxiety drug to his prescription apart from anti seizure and mood stabiliser drugs. Fluoxetine in high doses can control his symptoms of OCD. If his doctor agrees then mood stabiliser like Sodium Valproate can be used again in place of carbamazepine. The drug will help to control his behavioural symptoms. Discuss with his psychiatrist for prescription.Thanks, hope this helps you