Terrible day, but VNS offers some hope

John woke up at 4:15am and immediately started having seizures every 5-10 minutes.
He has done this before for an hour or two, but then will usually snap out of it. Today, he didn't snap out of it the whole day. We had his appt. at 9am to turn on the VNS. By that time, he had already had 60 seizures (15-20 clusters). He ended up with 48 clusters, and 98 seizures, easily his worst day ever.

He had his VNS turned on to .5 mA, on a 3 min off/30 sec on cycle. The first time it came on he gagged, and looked uncomfortable. So, it got turned down immediately to .25 mA, which is a really small "dose". The magnet activation was set to .5mA for 1 minute. John was having lots of seizures right in the office, even after the VNS had been turned on. So, we tried the magnet, and it seemed like it actually may have stopped the clusters. It's hard to know for sure, as some of his clusters are only 1 seizure anyway.
The rest of the day, we used the magnet every time we saw him have a seizure, which was a lot.
It seems like it IS working for all but the strongest seizures. It does not stop him from having a seizure in the first place, but does seem 90% effective in stopping the cluster after the first seizure. This is leaving us very optimistic, because this dose is just really low. I think there is a good chance that this will help him greatly at the higher settings. Time will tell. We're scheduled to have it turned up in 2 weeks.

Now we're trying to figure out why yesterday was so bad. It is very possible that this is due to the diet ratio. We're prepared to go back up on the diet ratio if he doesn't improve in a week. I was convinced that the diet wasn't helping him, but I'm not so sure anymore.

We are also going to continue increasing his Lamictal dose, but on opposite weeks of any VNS changes. The doctor didn't think it was likely that the Lamictal was causing his sleeping problems, but we don't know what else it could be. We tried giving him .5mg of melatonin last night, but it didn't have any effect at all.