An 8-year boy with h/o recurrent seizure for 4 years under the care of paediatric clinic referred as a case of intractable epilepsy without any family history of seizure and mental illness. no h/o birth asphyxia or any CNS infection or any developmental delay, school performance is worsening because of uncontrolled seizure, parents dare to send the boy to school, no focal neurological deficit. IQ is between 90-95, the pattern of seizure is changed from generalised tonic-clonic to complex partial type for few moments only in the last 1year.
Previously on phenobarbital and valproate combination. EEG is grossly abnormal showing generalized seizure network however no hysparrythmias or burst suppression pattern is seen, MRI brain abnormality is detected attached, metabolic factors within normal limit, serum Ca++ and Mg within limits, drug level of valprote was 77.7%. What would be the…
