Patient's question:
Currently, at 4 years and 3 months, the child cannot walk independently, can crawl, cannot speak, and does not recognize people. Severe infantile jaundice was detected on the 7th day of birth, with a jaundice index of 490, a fever of 37.5°C, and hospitalization for phototherapy. No blood transfusion was performed. The jaundice subsided after 3 days. At 20 months, the child underwent 4 courses of pediatric rehabilitation treatment, which had no significant effect and was discontinued. At 20 months, an MRI revealed an imbalance in the ratio of white and gray matter in the brain. At 2.5 years, epilepsy developed, with episodes lasting a few seconds and occurring 2-3 times, with attacks occurring every 2-3 months. Some treatment was administered. In the past 2 months, the attacks have become particularly severe, and antiepileptic medication has been started. Currently, the child is taking sodium valproate but still experiences seizures. Should other antiepileptic medications be considered?Doctor's answer:
Understand your feelings. Based on the information you provided, the child's diagnosis mainly includes: cerebral palsy, epilepsy, and intellectual disability. Currently, the child cannot live independently, and epilepsy still occurs despite medication, with seizures persisting even after medication.Actually, this epilepsy is a comorbid condition or associated disorder of cerebral palsy, not what you described as "causing it." In fact, you have only been giving the child medication for 2 months, and there are still seizures, which indicates that the medication has not yet fully taken effect. It is necessary to continue taking the medication to achieve effective plasma drug concentrations, control abnormal discharges in brain cells, and stabilize epilepsy to prevent seizures. Therefore, you need to persist for a period, such as 2 months. It is best to test the plasma sodium valproate concentration to see if it is within the effective range. If it is, continue taking the medication as prescribed. If not, it means the dosage is slightly too low, and the doctor should adjust it appropriately. Never adjust the dosage arbitrarily yourself.
The child's condition is quite severe, and currently, his functional activities are very poor, and his communication ability is also poor. Therefore, his rehabilitation treatment goals are to achieve basic or partial self-care. To reach this goal, training is essential, and rehabilitation treatment must be conducted in a hospital, otherwise, the goal cannot be achieved.
The prerequisite for his rehabilitation treatment is to stabilize the epilepsy. Only after the epilepsy is stable can he receive rehabilitation treatment and training.