Since you have had recurrent seizures despite dose adjustment, further evaluation is warranted even if the routine MRI and EEG are reported as normal. A normal MRI and routine EEG do not completely exclude epilepsy, as subtle structural abnormalities such as focal cortical dysplasia (FCD) or deep epileptogenic lesions can be missed on standard imaging.
I would advise evaluation at a comprehensive epilepsy centre. This may include a 3 Tesla epilepsy protocol MRI, 24-hour (or longer) video EEG monitoring to capture and localize seizure onset, and, if required, FDG-PET to identify areas of hypometabolism suggestive of an epileptic focus. In selected patients with persistent diagnostic uncertainty, MEG (Magnetoencephalography) can further help localize the epileptogenic zone.
Until the evaluation is complete, continue Brivazen exactly as prescribed and do not reduce or stop the medication on your own, as breakthrough seizures can occur with dose reduction or missed doses. The risk of recurrence depends on the underlying cause and seizure control. Many patients have normal routine investigations and still achieve excellent seizure control with appropriate treatment.
Next Steps
If seizures continue despite adequate doses of medication, early referral to an epilepsy specialist is recommended for a comprehensive work-up and to evaluate whether you have drug-resistant epilepsy, where advanced investigations and, in selected cases, epilepsy surgery may be considered.