<s>[INST] Hi doctor, I am a 43 year old man, who has lived with epilepsy since I was 13. I have had very few seizures, maybe one every 4 or 5 years. The last one was four months ago. After I had that one, I recovered and was fine, but about a month ago, I started having what seem like auras. They are different than the auras that I have had in the past. There are two types, from which one was not so severe. I will be working on something or thinking of something, and it seems like my brain just turns off for a second. These are distracting, but not very disturbing. I have several of these during the day, up to 15. The second type is more severe and disturbing. It usually causes me to jump with fright. For a few seconds, I can hear what is being said to me, but I cannot understand the words. Sometimes I can, but I must really focus. Sometimes, I can still speak, but I also have to focus hard. I might have two or three of these each day. Afterward, I have a headache that might last an hour or two, and NSAIDs do not help much. I take Tegretol, 200 mg three times a day. I was also taking Klonopin after the seizure four months ago. This has been going on for a month now with little change. It just started one day, and it has been the same ever since. I did not have any head trauma or seizure activity since the one four months ago. The access to healthcare here is good, but doctors get patients in and out as quickly as possible, so I do not feel like the doctor is going to do anything if I am not in danger. I have already had an MRI and EEG, and everything seems normal. It is just very upsetting because I cannot enjoy my normal life. Every time it happens, my head hurts, and I am scared and nervous that something is wrong. I am continuing to see the doctor, but I do not have much hope that it is going to help. [/INST] Hi. I have analyzed the symptoms you described in the query. The appearance and pattern of aura are actually suggestive of the fact that the electrical activity of your brain is out of control. Though it is not a full blown seizure, it is surely an early phase of seizures. I suggest you increase the dose of Tegretol (Carbamazepine) to 200-200-400. It would be best if you can repeat the MRI brain whenever the pattern of seizures changes. There is a possibility that something might have changed in brain structure also. When you go for MRI, please get an MRI brain epilepsy protocol. This protocol studies the medial temporal lobe region of the brain in detail. The way your seizures are; most likely they are coming from the medial temporal lobes. I hope my answer helps you. For more information consult a neurologist online --> </s>