Rolandic Epilepsy seizure cycles? Please share

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Niftwhich

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Hello all,

Can anybody with BRE in their lives tell me what time intervals they tend to have between seizures? My daughter just had another seizure tonight, making it five in a row. She has never had five in a row before; usually three, when it has been a longer period without seizures. Otherwise, she gets them on the average of every four weeks. She recently had an eight week gap, which is on the longer side for her; but, as we've been working on different therapies, I'm made nervous by this recent spate of seizures.

My daughter Z was diagnosed with BRE three years ago. This is a focal seizure disorder in which seizures are triggered during sleep. We have other sleep disorders in the family: apnea, even isolated paralysis incidents associated with narcolepsy. Sleep problems are our specialty. Benign Rolandic Epilepsy is usually not treated with medication.

When our health plan changed and we got a new neurologist a year and a half ago, she questioned whether the "B" for benign should really be there, and told us to put Z on Keppra. I was reluctant, but we agreed to try a small dose. Over the next year and a half, the doses kept increasing every time we went in. The seizures didn't stop. I did some calculations recently and found that the seizure frequency and duration for both before and after Keppra were the same. Keppra was making Z miserable; she no longer wanted to talk to her friends, took pleasure in almost nothing, and was incredibly slow to speak (had an IQ of over 150 when all this started. She's always been methodical, but she now literally couldn't finish any of the sections of the standardized tests she had finished in previous years, getting 60% of her prior scores. Brain damage or Keppra? We decided to take her off the drug. We tapered doses down over four weeks, keeping her on a new, ketogenic diet the whole time. Changes in Keppra dosages had often precipitated seizures before, so we wanted to do something protective. We used a lower ratio so that

She went eight weeks without a seizure, the longest gap she'd had in a while. I charted and calculated the ratios of all her foods, keeping her at a 3 to 1 ratio (in calories; 2.5 to 1 in grams) as that was the ratio recommended by Dr. Perlmutter for general brain health. We weren't going to be able to see the new neurologist for two months, so I didn't want to do something extreme like a 4 to 1, which would require a dietician's help and doctor's surveillance. We had used urine test strips to make sure she was in ketosis; we started neurofeedback and removed casein from her diet as an extra precaution. Z got the light back in her eye, her old, affectionate ways came rushing back, she was a champ about the new dietary restrictions, and I felt like a rock star. She had been completely off Keppra for a week, her neurofeedback was reporting a reduction in the range of

Then she fell asleep in the neurofeedback chair and seized for two minutes.

She had a tiny little solo in her school choir concert that night; she got her coordination back in time to do it. She then had these smaller, 20 second partials every night since--four nights. We have managed to move up our neurologist appointment, but it's still two weeks away. I have been a mess, wondering whether I should take her to clinical levels of the ketogenic diet (3 to 1 or 4 to 1 ratios of grams fat to grams protein and carbohydrate combined--our ratio is based on calories, so slightly lower/safer)

I'm beginning to wonder if my use of hemp oil in the early days of her new diet was part of what was helping. We ran out recently. Her neurofeedback doctor gave me a prescription yesterday for CBD hemp--thank God we live in Washington--and I plan to fill it tomorrow if I can (I don't really understand how it's done, and can't quite believe it til I get it).

I know that the short seizures are less damaging. Still: I can never sleep well while I'm listening for bumps on the wall, and I am longing for some hive mind reassurance about the nature of BRE.

Thank you!
 
Hi Niftwich, welcome to CWE!

I know we have several members familiar with BRE, and I hope they chime in. And I hope your daughter's neurologist can provide some perspective as well.

It sounds like you aren't 100% sure of the BRE diagnosis? I assume your daughter had an initial EEG done, which presumably showed the characteristic pattern associated with BRE. You might look into having another EEG done to see if the patterns have changed. It could also be that her BRE is atypical, which can make things tricky. Unfortunately BRE, like other forms epilepsy, can play out in a wide variety of ways, and there's not enough predictive data out there.

As far as treatment goes, it's terrific that you are able to closely monitor your daughter's health, and keep track of what works and what doesn't. It's great that you are pursuing alternatives, and I hope they pay off.

As you've found, it can be difficult to draw a straight line between cause and effect for both seizures and treatments. Some treatments can take several months to show results, some may make things worse, and there may be things that you can't control for such as your daughter's changing metabolism.

I hope you're right about the hemp oil. In some ways it's a just as much a drug/medication as Keppra, so it's quite possible that the loss of it from her diet could have resulted in an increase in symptoms. Did your daughter's neuro explain why Keppra was recommended in the first place? Studies have suggested that anti-seizure meds don't help control partial seizures in patients with BRE. And if generalized seizures occur, the first-line choices are usually Tegretol or Neurontin.
 
Thank you, Nakamova!

Thank you for your encouragement. It's amazing how comforting it is to hear from someone who is not either

a) a doctor/representative of a power structure who wants you to go with their recommendation, or

b) anybody, doctor or family or friend, who: like you, just wants the scary to stop; and, unlike you, believes that if the situation is not controllable, it is due to your (parent's) decision.

I had no idea that Keppra wasn't the first line of defense for partial focal seizures. Some of Z's turn tonic clonic, so maybe that explains the choice. She may be, as you say, atypical BRE. We had both EEG's and a three-day VEEG, and the activity was definitely in the Rolandic area--but there was also some spiking from the occipital lobe. I get blinding migraines, and the theory is that my cortical reactivity combined with the BRE genes might make her seizures spread rather too rapidly. I think I let the doctor's smile override my concerns; have to watch that, in future, MamaBear Gatekeeper: it is so easy to want a solution, to want to leave it in someone else's hands! But perhaps that is one of the gifts of epilepsy: to know that concepts like control, and hands, and control of hands, are temporal at best, even unreliable--and that unreliability is to be loved and stretched around and understood as a tool of humility and psychological discipline.

We picked up the CBD drops tonight: having never used marijuana, I felt odd walking into Seattle's Marijuana Mall--even got some judgmental looks from the recreational types, with my eleven-year-old daughter on my arm. Thought I was starting her a little early! She was a champ, though; laughed that she's going to tell everyone in fifth grade that she uses marijuana. We may have some issues there. But the pure CBD tincture that Seattle's Best Cannabis sells has apparently helped other local kids. I'll keep you posted. Seizures usually happen 45 minutes after bedtime.

Thank you again!
 
It may be that your daughter's neurologist had had success with Keppra and BRE patients before. Keppra can be ramped-up fairly quickly so that may be another reason he suggested it. It seems that an aspect of epilepsy treatment can be trial-and-error; hopefully, better testing and more focused treatments will make the process less stressful in the future.

Definitely keep us posted on how she does with the CBD drops. I know a lot of CWE members are curious about marijuana or hemp-based treatments (and frustrated by lack of access/data).

I'm also interested in how your daughter was responding to neurofeedback. Was her neurologist on board? How many sessions has she completed, and will you be continuing with additional ones? I would like to try neurofeedback as an alternative to medication, but my neurologist is very dismissive of nfb for treatming epilepsy. There are also no nfb therapists nearby who are familiar with epilepys protocols. And then there is the cost...

Just out of curiosity, do you take medication for your migraines? Do you and your daughter share particular secondary triggers?
 
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Recently, after 16 years everyone realized that the high point of my seizure activity, migraines and general tires, weariness was linked to my menstrual cycle. I am currently on Keppra, Lamictal and a 3 month cycle of Depo-Privera which is progesterone.
I have a great improvement. Every now and then I will start up with the seizures and horrific migrains then I look at my calendar and realize I am due for the shot. I have def. learned how to listen to by body.
 
hi Niftwhich (& others),
I hope this note conveys some sense of empathy and solidarity to you.

I also have a daughter with BRE. She is 11 yrs old now and was diagnosed 6 1/2 years ago after a tonic clonic seizure and EEG. At the time she was put on Trileptal, which worked very well. As far as we could see, she had no seizures for 6 years. After the first 3 years, the neuro took her off the Trileptal, and so she was seizure free without meds for another 3 years.

Then 6 months ago, her seizures returned. Five months ago, she had 4 seizures within a 12 hour period, with vomiting during or after each one. The neuro put her back on Trileptal immediately, and since then, she has had only a few break-through seizures --2, however, have progressed to tonic clonic. All of the seizures since 6 months ago have been daytime and have involved severe vomiting. Notably, both of these characteristics are not typical for BRE. She also has music auras --again, highly unusual for BRE, according for our neuro.

This is all to say, much of what has been happening with her is not typical at all of BRE, yet her diagnosis has not changed. This has all been troubling (partly because I hope it is BRE, because that means she will eventually outgrow it), but I have been comforted somewhat by an article from pubmed, the findings of which indicate (as far as I can tell, given the medical-speak) that MOST cases of BRE are atypical. (Because I am new here, the system wont' let me post links, but if you google "Benign Rolandic atypical" the article will come up close to the top.)

There is much that is distressing about epilepsy. A major thing for me is how unpredictable it is in so many regards --the effectiveness of treatments, the triggers, the seemingly random timing of the seizures (for instance, we had nothing for 6 years and then, bam! back again), and so on.

Because each case is unique, I think you are doing the right thing in trying different dietary regimes and supplements. My daughter is also on B6 (neuro recommended), and I am also going to try Omega 3/ fish oil supplements --some people online have highly recommended that. As I mentioned, the Trileptal seems to be working well, but we have still had break through seizures, and I would love to see those go away.
I hope you are able to (or perhaps have already found) treatments that work for your daughter and can therefore obtain some peace of mind --all the best to you!
 
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