Hello all,

I was hoping that some of you might shed some light on some questions
that I have.

First - a bit of background.  My husband was diagnosed with epilepsy
3.5 years ago.  Prior to that he had several "fainting" incidents over
10 years that were never properly diagnosed (even by docs at Stanford
and Mass General).  He was finally diagnosed after pulling to the side
of the road after feeling light headed - a grand mal followed and he
was taken to the ER by ambulance.   I was pregant with triplets and we
were building a house at the time (I had to giggle at a thread on this
board about "triggers"...I'd say that my dh had several at the time!).
An MRI showed a lesion on the left temporal lobe.  He was first tried
on Tegretol (not well tolerated), then Dilantin (around 500 mg).  He
had auras about every 30 days - and prevented grand mals with Ativan
after any aura (which typically knocked him out).  After the triplets
were born (talk about sleep deprivation!) and the house project turned
into a complete nightmare - his seizures increased to the point that
he had two grand mals in a row one morning last May (without warning,
which he typically had gotten in the past).  We promptly put the new
house on the market to reduce our stress.   Turned out his Dilatin
level was low (less than 10) - so it was upped to 600 mg.   After
selling the house and he stopped working, he was seizure free (and not
many auras) for 1 week shy of 6 months in Nov. (the magic "go back to
driving/work") when he had the flu/missed meds for 12 hrs./little
sleep/no breakfast/morning at the dentist, and he had another grand
mal.  He then had a few auras in Feb.

We went to a new doctor last month at a major med. center (here in the
Bay Area) who says that my dh should have been put on a new medication
(as a primary or secondary)  a year ago when it was clear that Dilatin
wasn't doing the job.  The new doc is  also pro-surgery.  From what
I've read, surgery can have very good outcomes..but naturally we are a
bit concerned about it.  He'll be having video monitoring (forced
seizure) in about a month to see if he's a good candidate.  In the
meantime, the new doc  started him on Keppra (low dose) in addition to
560 of Dilatin (his blood level is now 18).  The last month has not
been good as my dh sleeps about 3 hours every afternoon and he is
angry all the time.  He finally called the doc yesterday who said to
stop the Keppra (thank goodness!).  My dh hasn't worked or driven
since last July - which is beginning to be a issue.

So....the questions are:  

1)  what other drug should he try in addition to Dilatin?  (I know the
chances of another drug working is only about 10%)

2)  is surgery a good road to follow?  

3)  how do you find the best neurosurgeon for this type of surgery?
(the options for us in the area are:  UCSF, CPMC, or Stanford).

Thanks so much for your sage advice....I have found that peer advice
can be the best - I did it for fertility and look what happened!  Now,
we just need to address my dh's epilepsy with the same fervor and
hopeful outcome.

Deb