Hello doctor, My 26-year-old wife got her first seizure one year ago and she gets the seizure once every month or two although all her checkups are fine with no sign of epilepsy. The doctor put her on Keppra 500 mg and she still gets her seizures and complains a lot of side effects. I am wondering is it catamenial epilepsy or PNES. Please advise. Of note, we are planning for a baby too.
Hello. Regarding your concern, I would explain that the catamenial epilepsy is a very specific type of epilepsy where a seizure occur every month at the same time closely related to the menstrual cycle. This type of epilepsy is usually refractory to many epileptic drugs. Anyway, the dose of Levetiracetam that your wife is taking is low. If she does not tolerate this drug, it is not possible to raise the doses. Coming to this point, considering the fact that you are planning to have a baby, I would recommend switching to Lamotrigine starting with very low doses and increasing gradually up to 100 mg per day. Further increase in the dose may be done later up to 200 mg daily if her seizures persist.  Another possible treatment would be Acetazolamide taken usually for some days every month before the time when seizures usually occur. Consult your specialist doctor, discuss with him or her and with their consent take the above medicines. Meanwhile, I would recommend checking her thyroid hormone levels to exclude the possibility of thyroid dysfunction which may trigger seizures. I would also recommend to video register her seizures if possible in order to have a more professional opinion on the type of her seizures. It is not rare to have a normal EEG (electroencephalography) during seizures. That is why video registering is necessary. A prolonged EEG study for a week with video monitoring EEG or a sleep deprivation EEG would give more information on her seizures. Hope you find this answer helpful. For more information consult a neurologist online -->