More than 90% of my seizure happened when I was sleep

Thank you Jake, and thank you Chris! Thank you both to answer my questions, and provide supports!
I am pretty luck in a sense that the first neurologist I can get appointment is an epileptologist. My dose of Keppra increased from 500 mg, twice per day (10 days no effect) to 1000 mg, twice a day, now more than 10 days, till no effect - seems more events than before the drug. I will have another appointment next week. Hopefully the doctor can make some changes. Jake mentioned branded drug vs. generic, and extended released form drug. I will ask my doctor about them. Jake, the first option drug for Sleep-related Hypermotor Epilepsy is carbamazepine. I will ask my doctor about it too. What is your opion on patient educations? Do you think doctors preper patient know more, asking a lots of questions, or they prefer patient just follow their direction - I guess each doctor is different. I am afraid to get my doctor mad by asking too much questions.

@jakedduck1 Hi
Jake, I really appreciated your perspective on not letting epilepsy dictate our lives. That resonates deeply with me. I was also struck by @closetmonster93 comment in another discussion about embracing epilepsy as part of who we are rather than fighting against it. Both viewpoints offer such valuable insight into living authentically with this condition.
Have a nice day!
Chris (@santosha)

@jgu
Good Morning Igu,
I'm glad our comments are helping you on your journey.
If Keppra is increasing your seizures, please contact your doctor immediately rather than waiting for your next scheduled appointment. I recommend keeping a seizure journal with daily notes about your activities, feelings, and any seizures you experience. This will provide valuable information for both you and your doctor during appointments. I'll share an example in a separate comment.
I exclusively use brand-name medications, which I believe is the best approach here in Brazil. From what I've learned, it's crucial to consistently take your anti-epileptic drugs (AEDs) from the same manufacturer, as there can be variations between different generic versions. @jakedduck1 can provide more detailed information about AED medications in the US.
Education about epilepsy has been extremely valuable in my own journey. It not only helped me understand my condition better but also enabled me to provide doctors with more precise information about my symptoms and experiences. Since my epilepsy diagnosis in early 2019, I've consulted with several neurologists and psychiatrists. Some seemed uncomfortable with my desire to learn about and study my condition. My current doctor values and encourages my knowledge about epilepsy, which an important aspect to me. You might consider asking your doctor how he or she feels about patients being actively involved in understanding their condition.
I'm sharing a comment I wrote previously about what I wish someone had told me at the beginning of my epilepsy journey.
https://connect.mayoclinic.org/comment/1309833/
Have a nice day!
Chris (@santosha)

@jgu
Hi Igu,
Here's an extract from my epilepsy journal showing entries from two different days. I was advised to maintain this journal daily, even on days without seizures. For my medical appointments, I prepare a summary that includes the number of seizures, seizure types, duration, triggers, and other relevant information.

August 4th
Woke up around 8 AM to watch the Olympic tennis finals between Djokovic and Alcaraz. I was cheering for Djokovic. The match was very tense, and I noticed increased stress after the first set. I decided to stop watching the match fully and muted the TV, only checking the scoreboard occasionally. Djokovic won, which made me very happy since this might be his last Olympics.
I and my husband went to lunch at a familiar Lebanese restaurant. I had water, salad, and stuffed grape leaves. We returned home at 3 PM, and I began my rest period with yoga nidra.
I woke up around 4 PM and went to the living room, asking my husband if it wasn't time for lunch, even though we had already eaten. I felt somewhat confused, but could speak clearly. I experienced significant nausea, chest pain, and muscle aches. My husband observed that my heart rate in a resting state was quite high (nearly 80 bpm). After resting for another hour, it decreased but remained elevated (70 bpm). The muscle pain improved with the cream my husband applied, and the chest pain and nausea subsided. I developed a headache afterward.
Reflection: Did I have a seizure during my rest? My husband doesn't think so since I could speak clearly. The confusion with my odd question about lunch disappeared within minutes. If this was a seizure, sleep would have been the main trigger, as I only had 19 minutes of deep sleep the previous night.

September 19th
I had a productive morning with a brisk walk and arrived on time for my spiritual meeting.
The seizure occurred just as my weekly spiritual meeting was starting. I remained quiet for 30 minutes before seeking my husband, who helped me to bed. I felt warm with a slight fever, had difficulty communicating, and felt cold. The triggers were likely two consecutive nights of poor sleep (Tuesday-Wednesday at the hospital with
my father and Wednesday-Thursday at home) and stress about my father's pneumonia. I felt extremely exhausted for the rest of the afternoon.
I got up at 1:30 PM for lunch, though I had no appetite, then returned to bed until 5 PM. I accomplished very little for the remainder of the day.
Seizure Details:
Type: 1 Complex Partial seizure
Time: 11:40 AM
Duration: 30 seconds
Location: Home
Severity: Moderate
Triggers: Stress and sleep deprivation
Precursors: Father's pneumonia diagnosis
What helped: Remaining quiet
Impact on my day: Missed my Pilates session and postponed other activities
Impact on others: none

@jgu
“What is your opion on patient educations?”
I have been to doctors who definitely want you to sit there with your mouth shut and other doctors who were happy to answer questions. I could care less if I make my doctors mad. They are my employee. They are on my dime. my primary care doctor and I go around and around. Now she usually just sits there and rolls her eyes. In the past, she often would leave the exam room before I was through asking questions so the next time I went, I stood in front of the door the whole time. She said I need to leave. I said “no you need to answer my questions.” Obviously I’m not my primary doctor's favorite patient. I don't like taking a bunch of prescriptions where she was giving me and I didn't need any of them so at that time I was just taking them, but I finally wised up and stopped. Now she asks me “may I give you a prescription” I say “if you can convince me why I should take it.” suppose I do try and run the show but why not, it’s my dime (or more accurately my $150.)
To be honest, I wouldn't worry about making the doctor mad. If he's a good doctor, he should appreciate every question you ask. If he doesn't, it might be time to search out a new doctor which I know is a near-impossible task now days. As far as asking your doctor about one of the carbamazepines, brand names, and extended-release. I can hear him now. Generic and brand-name drugs are identical. I bet you a buck that's what he says. It's true many people take generic drugs and do fine on them. I just don't happen to be one of them. My last Neurologist, who since passed away, been a long long time explaining the benefits of extended release medication. He drew charts and graphs and everything else. after I started taking extended release drugs, my seizures stopped. i'm not saying that that will happen for everyone, but it happened to me after 45 years at over 13,000 tonic chronic seizures. It's evidence enough to prove to me that it was the extended release formulation that stopped my seizures.
My brother, who also has epilepsy was taking the brand name with every refill, but then one day 20 years of no seizures, and they filled his Tegretol (a brand name of carbamazepine with a generic and he started having seizures. When he went back on the Tegretol, his seizure stopped.
Stanford University in California did a study and they're the ones that showed people should take the same manufacturer with every refill and not switch from brand to generic or from generic to brand. I've been looking for that study, but I haven't been able to locate it as of yet.
also, I'd ask the doctor, do you mind answering my questions? Don't forget, doctors are often wrong when diagnosing epilepsy. I have asked more than one doctor. “How do you know your diagnosis is correct or do you?” even if they tell me and I'm fairly well convinced I'm still somewhat skeptical. Also, your doctor should allow you to participate in your care. I used to take the seizure medicine Dilantin however it became unstable and so I had to switch my neurologist first suggested I take Topamax. (known in some epilepsy circles, and even some neurologists call it Dope-a-max.) I knew someone in England who went blind from Topamax. It can cause high interocular pressure and I already had glaucoma with high pressures and was being medicated for it, but even though I may never have had any eye issues, I didn't want to take any chances. told him I refuse to take that drug and he had no problem with it and that's when he mentioned the extended-release Carbatrol. I was familiar with carbamazepine because my brother had been on Tegratol for so long. Not that that's the only reason I chose to take it.
Take care,
Jake

@jgu
If your increased Keppra causes any mood issues, known as Keppra rage, B 6 my help. Ask your physician about dose.
Take care,
Jake

Hi Chris, and Hi Jake, thank you both so much for sharing your experience! I use an app on my phone - Epsy: Seizure Log for Epilepsy to track my seizures, medications... Seems working - I can put notes in the app too. I do have some mood change - sad, depressed... I will ask my doctor about the vitamin B6 - thanks Jake! Thank you both to share your experience with doctors about patient educations. I do believe we are the best doctors for ourselves because we know us the best. However, not every doctor agree. We depend so much on our doctors - for diagnosis, for treatments... I was so lucky that I found an epileptologist right after I realized I might have seizure, and I booked the appointment the next day. I was told if I do not take that appointment, the next available time will be more than a month later. I can only got appointments for my EEG, brain MRI almost a month after my first doctor's appointment.

@jgu
Hi Igu,
I've been thinking about you and wondering how your tests went.
Were you able to discuss the results with your doctor?
Chris

Igu
Take the tests and see what's happening. sometime is changing if you've starting these nighttime seizures. My son has them too ( scream and wide eyes. Have your wife record your movements and facial expressions do you thrash your arms and legs around and do you turn your head one direction or the other. all that data that might help your doctors determine but they've developed into awake seizures which are very dangerous to due fall risk.
My son takes 4 different meds and they help some but don't' control them.
He also has had laser surgery and a VNS implant. Get tested stay ahead of any changes that might be developing May i ask your age. Were you on a meds earlier in life?
James

Also suggest you get a cheap Ring type of camera and set it up in your room to capture any video footage of you having a seizure. Doctors love that type of diagnostic data.
in closing, suggest you keep a daily journal of how you're feeling and any seizure events