A 7yrs old child a known case seizure disorder was on oral phenytoin from some local practioner for one year,seven months back he had a episode of gen seizure and was in status. was managed coservatively and was noticed that he was having inadequate dose of phenytoin.A repeat EEg was done which showed a seizure activity,neuroimaging was normal study.HE was started on sod;valporate in stead of phenytoin ( valporate dose-25mg/kg/day),he remained seizure free for seven months after that but now again had a gen;seizure but not status. do i need to start any other add on drug like Lamotrigine? I simply increased the dose of valporate to (30mg/kg/day) with which seizures are well controlled.

You may get TDM levels of valproic acid and if it is low, doses can be adjusted. Since the child was seizure free for 7 months, it is unlikely, that additional drug will be required.