Initial EEG's were normal, but as time went on they became progressively more chaotic and disorganised and described as highly abnormal although not displaying typical hysparythmia. She appeared to have both focal and generalized seizures intermittently. MRI's, brain ultrasounds, biopsies and more metabolic tests than I can remember, all came back normal.
Epilim, Pyridoxine, Phenetoin, Phenybarbitone, and Carbamazepine didn't make a dent in her seizures which by 6 months old were hitting 30-40 day on good days and well over 100 on bad days. Vigabatrin and Nitrazapam initially appeared to be the miracle we had been waiting for with no seizures for over a week in January 05, but our hopes were short-lived and Niamh began to fit again. Prednisilone (steroid) was added with no effect and then Topirimate which made things worse.
Her rescue drugs were Diazepam, Lorazepam and
Paraldehyde but they started getting less and less effective the more we used
them. When we were using them on a daily basis and they were not even helping
we were lost as to what we could do.
The next 6 weeks of weaning off the medication was hell. I wondered many a time if I had done the right thing as Niamh went into status
(state of continual seizures) for 4 weeks and into a persistitative vegetative
state for 2 weeks. The main reason for her deterioration we understand was the withdrawal of the
Nitrazepam. Our 12 month old baby was going through the most horrific 'cold
turkey' you wouldn't wish on your worst enemy. So bad in fact that the last 2
weeks her body just decided to shut down.
Niamh had been on Nitrazepam for 8 months (since she was 4 months old) and by the time we started weaning her, she was on 4mg twice a day. We had heard weaning would be tough - we just hadn't appreciated how difficult it would be. I cant tell you the number of times I sat beside her hooked up to her saturation monitor and oxygen just shaking like a little jelly day and night. I will never forget those times. To make things worse, Niamh's rescue drugs of choice were Diazepam and Lorazepam - both of which are from the same family and therefore had stopped being effective. We had moved on to Paraldehyde as a rescue drug, but that was no match for these withdrawal seizures and in the end, we just had to be brave and let her body deal with the withdrawal itself.
The difference I think with Niamh is that she was so incredibly ill with the frequency of her seizures prior to the withdrawal, we really held firm the thought that we were doing the right thing regardless of the outcome. I suspect that this is not the case for all parents withdrawing their kids from these drugs, so I'm not suggesting our action would be right for every family. The week we reduced the dose to zero, Niamh went into a comatosed state (although she was still fitting). But then out of the blue, 2 weeks after the dose had been cut to zero (and 6 weeks after commencing the ketogenic diet), she opened her eyes and her fits had gone.
Light at the end of the tunnel
Getting her off the Nitrazepam was the best thing we have ever done , I
personally believe (though there is apparently no medical foundation for this)
that the anticonvulsants were making her seizures worse (or at least different)
even before the withdrawal. Very gradually some things have started to come back
to Niamh. At first it was just wiggling her toes, then fingers, moving onto
legs then hands. After 2 months she had learnt how to cry again and had given
us a very long awaited smile!
We are thrilled we have had such a success with the ketogenic diet, however the seizures (or the drug withdrawal, we do not know) have unfortunately left Niamh with severe brain damage.
Although she can smile at noises and touch, she does not use her vision anymore, she cannot hold her head or sit, she is fed via tubes into her stomach and another into her small intestine (jejunum) and she is fully dependent on us for all her care needs and always will be. Because her brain is damaged, the impact on the rest of her body is immense and she battles on a weekly basis with health issues including; bouts of vomiting uncontrollably - severe reflux (made worse we were told, by the high fat content of the ketogenic diet and the fact it sits in her stomach for longer).
She remains on lots of anti-reflux medication, antispasmodics,
and anti-inflammatories to stop her stomach bleeding, and to reduce her
sickness. She has also had an operation called a fundoplication to tie a knot
in the top of her stomach to stop her being sick, but bless her, she manages
to baffle her doctors by just being sick through it! She has a gastrostomy and a jejunostomy for her day
and night feeds respectively, but she still has bad weeks where her gut and
bowel just work in reverse (anti-peristalsis) and she will only tolerate water. She has severe scoliosis (curving) of her spine and
has to wear a back brace, and she has developed a movement disorder, likened to
Parkinsons, that means she trembles constantly and has bigger more severe
dystonic spasms that upset her a lot, and mean she cant catch her breath and
so cause her to go blue.
On a more positive note - She can now chew a dummy and does smile and laugh in response to noises and touch. She loves being tickled. She still has a problem with her vision, but on good days she will hold her head up and sometimes she will gently grip objects placed in her hand. She now recognises her mum and I can calm her down if she is upset (sometimes) - its the best feeling in the world. Niamh is now off the ketogenic diet as she became very underweight, but she still remains seizure free. I know we are always going to have a very disabled child, and we know she will battle with her health for the rest of her life but her quality of life has improved beyond belief thanks to the diet and all the MPEI friends and professionals that have helped us get where we are now.