Off Depakote, on Zonisamide - Yuck...Got to Move On!!

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frshbeat

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Hi,

Even though I'm new here, I've read through quite a few of the stories in these forums and I feel like I'm one of the team. Here's my background.

I begin having Grand Mal (tonic-clonic) seizures since at the age of 5. At around the age of 20, I began to take Valproic Acid, before Abbott ever branded it Depakote, and even before it was a legal drug in the USA, over 30 years ago.

At that time, I was put on it on an experimental basis. I was a patient through a neurologist at UCLA. Back then, Valproic Acid was branded as Epilim in Europe. It was easily purchased over the counter and my father had friends who smuggled it into this country. It was strange that I had signed the waivers, but we still had to go outside the country to get the drug.

Prior to getting onto Valproic Acid, the last drug I'd been taking was Dilantin. It hadn't been very successful as I experienced frequent head shaking, (myoclonic jerks) throughout the day. Stressful situations always seemed to be one primary indicator that could ignite this myoclonos activity, aggravate and propel it. They only lasted for a brief second or two and I was always conscious. They were just greatly distracting and taxing on my brain. Successive, incessant jerks would be the precursor to developing into a major tonic-clonic seizure. In a years time, I would usually end up averaging about three or four of these tonic-clonic seizures.

Even before the full transition into Valproic Acid, my head had become still. It was finally in a calm place, absent of any head shakes. OMG!!! At that early stage I was confident that seizures would no longer restrict me as they had. My world was going to change drastically and I knew that better things were coming. A big gain was being able to interact and function socially in a way I was never able. A door had been unlocked and a new path was unfolding. It was a very cool time. Being seizure free didn't guarantee unlimited serenity, but what a game changer.

The drug was finally FDA approved for Abbott Laboratories approximately one and a half years after I began using the Epilim version. The version I used was named Depakote. I was using a 1500 mg a day dosage.

Unfortunately, after 30 years of being seizure free, other side effects were becoming evident. Over the last several years, I'd experienced some occasional stomach pains. They were severe and I knew the Depakote had contributed. I hadn't been seeing a neurologist for over 20 years and had only been seeing a GP to have my blood levels checked. Those had been fine.

I finally decided to see a Neurologist. He chose to get me off of Depakote due to the length of time I'd been on it and the effects I'd experienced. I'd been advised that newer, safer AED drugs were available. The choice was to get me on Zonagran, (Zonisamide the generic version). It was touted as being a far less risky option in terms of side effects with no need to do blood levels. Most importantly, it was expected to manage my seizure condition.

The transition was a nightmare. It started in early April of 2011 and lasted for 6 weeks. During the transition stage, Depakote and Zonisimide created a very strange condition, especially having to work and drive. You could walk, you could talk, but at certain times, you felt that your motor skills were being under-clocked. Things got just plain weird. It felt odd to drive and work, and it even slowed my pace with "Words with Friends". :ponder:

There were also slight head vibrations that interrupted my sleep. When lying quietly on a pillow, I'd occasionally swallow while sleeping and then experience these slight vibrations. They were all mostly annoyances, but enough to disrupt your otherwise normal day. According to some specialists at USC, these may have been due to the dominant characteristic of Depakote while in combination with most any other AED while in a transition period.

All the weirdness subsided and life calmed down when I finally stopped taking the last doses of Depakote and went primarily on Zonisimide. However, being on Zonisamide definitely has a lower efficacy on me than I had with Depakote. This was my greatest concern about making a transition off of a drug that gave me a life that was seizure free. Even better, how about all this is enough to just fricken scare you *hitless. I don't think there is any better way to doll up that one.

Moving right along. I now experience a slight bit of myoclonis, maybe one to three head shakes a day. Sometimes I can go days without. Compare that with Depakote in where I would experience a head shake maybe one or two times a year. However, most importantly, I've had no tonic-clonic seizures and I definitely feel those are still under control.

Aside from the lower efficacy of being on Zonisamide, I can't stand the numbing sensation it leaves in my mouth. I've heard that it's one of the known side effects. Even though this drug doesn't require blood work, it's hard to understand that a drug that leaves a numbing sensation in your mouth can be so good for you.

I spoke to my neurologist and expressed my concern in getting off the Zonisamide. He said there were other drugs options that may work with my seizures and may quite possibly have a lesser degree of side effects than I'm currently experiencing. His choice was Keppra or Lamictal. Somehow he had a feeling that I'd be reading up on whatever he proposed. He then told me that after my research I could let him know which drug I'd feel more comfortable to start with.

Decisions, decisions...blah, blah, blah. Which new seizure drug to choose? If anybody has an understanding or similar experiences, all your feedback is greatly appreciated. I'm taking notes.

Btw, I've also looked into the alternative section and read about Piracetam. If anybody's had any experience with this supplement or other alt's, I would like to hear more about those as well.

Hope the novel-like approach wasn't too lengthy for the forum. Sometimes the synapses just snap into overdrive. And, thought the Depakote story might be of some interest.

Thanks
 
Hi frshbeat, welcome to CWE!

I gave Zonisamide a shot, but the side effects were a deal-breaker, and I eventually transitioned to Lamictal. While in theory you don't need to get your drug levels checked with Zonisamide, your neuro should have tested your serum bicarbonate before you went on it and while you are on it now, due to the risk of metabolic acidosis. More info here: http://www.fda.gov/Drugs/DrugSafety...mationforHeathcareProfessionals/ucm095251.htm

The FDA warning came out after my stint on Zonisamide, so I don't know if that particular problem was what was affecting me. I definitely had issues with fatigue, loss of appetite and a painfully acid stomach. Since fatigue and low-blood sugar are seizure triggers for me, I wanted off the med, something my neuro agreed to once I had a massive seizure.

Lamictal has been okay for me. No problems with seizure control (seizure-free almost 4 yrs), and side effects that are tolerable for now. I'd love to find alternatives, but past attempts to go med-free haven't been successful. My hope is try neurofeedback when I get some extra cash, and see if that can help me reduce my dose in the future.

There's a lot of info here about individual experiences with different meds. Unfortunately there's no way to predict how any one person will do on a given med, but you can at least get some idea of the range of reactions.

Best,
Nakamova
 
frshbeat , reading with real curiosity, thank you for sharing, you think stomach problems due to meds? 20 years on Valproic seizure free and they did not suggest you stop any time?
 
frshbeat , reading with real curiosity, thank you for sharing, you think stomach problems due to meds? 20 years on Valproic seizure free and they did not suggest you stop any time?


Every stomach pain occurrence seemed to coincide with eating out at an establishment where I indulged in foods that were fried or cooked in large amounts of oil. Still, I always had those Depakote warnings in the back of my head - the relationship to gastrointestinal, stomach, pancreas warnings - yes, they were always perched.

To get a better picture, an insight into my lifestyle might help. It was not common for me to go out and eat fatty foods, especially fried. I'd felt I could beat the odds by fueling my body with the most nutritious foods available.

For me, I became a vegan. And I got healthier. I get lot's of protein, lot's of raw fruits and vegetables, legumes, vitamins, B-12 supplements. And, I avoid processed foods at all costs. My body has been in a healthy state. I love running, biking, hiking and doing things that are known to keep us fit, smiling and in touch with the planet. My weight and heart rate have been fine. Eating fried tempeh with lots of vegan mayo is an unusual thing for me.

So, why did I not do anything with these occurrences happening a few times over a ten year period? I just used to look at it as, "Depakote, nah, toughen up and eat better." But more honestly, I liked my seizure free life. Deep down I was afraid somebody was going to take it away. The things one might suffer through. It was my old "coping" method. I should have seen a neurologist at least. Newer drugs were available unbeknownst to me.

It wasn't even a stomach pain occurrence that finally sent me into the neurologist. I was just that damn elephant in the room.

Thanks for asking Chaz1. I'm now on a path of exploring the newer meds available. This time around I'll be diligent in giving my doctor any and all feedback, regardless. Hope all is well with you.
 
its good u take care of yourself but i am on both lamictal and keppra i would give lamictal a shot first im losing my memory bad and im not certain but pretty sure from keppra both work effectively but can mess with stomach i was healthy as well and still very active but problems with my stomach and my pcp sees no other answers?
 
Hi frshbeat, welcome to CWE!

Lamictal has been okay for me. No problems with seizure control (seizure-free almost 4 yrs), and side effects that are tolerable for now. I'd love to find alternatives, but past attempts to go med-free haven't been successful. My hope is try neurofeedback when I get some extra cash, and see if that can help me reduce my dose in the future.

Hi Nakamova,

So Lamictal was okay for you and tolerable? Is there anything specific that I might watch for if I switched over to it? I understand our bodies are all different, but it's just good to hear others experiences. I was concerned about the serious rash warning and mentioned it to my neurologist. If not mistaken, I believe I was reading something about "drooling" that you might have posted in a thread.

And thanks for the Zonisamide warning. I was aware of that after I begin taking the drug. I switched to a new neurologist after I uncovered that finding along with a few other issues. The new neurologist concluded that I was in great health, and it was not a concern to test my serum bicarbonate levels. Still, I'm feeling a bit cautionary in regards to my neurologist since it's only a test. Especially after hearing your response, it's just another reminder.

Anyway, even the Zonisamide I'm on may have the potential to cause serious rashes. I haven't experienced anything like it yet. And besides, I never experienced all of the side effects that Depakote had warned of during a thirty year stint.

Finally, Keppra was the other choice given. Haven't had any response to that drug. Have you had much insight on it?

Thanks so much.
 
its good u take care of yourself but i am on both lamictal and keppra i would give lamictal a shot first im losing my memory bad and im not certain but pretty sure from keppra both work effectively but can mess with stomach i was healthy as well and still very active but problems with my stomach and my pcp sees no other answers?

I'm so sorry you are starting to lose your memory. And how it really must be disappointing when you are taking good care of yourself and staying active.

Do you think it's a result of maybe only one of these two drugs, the combination or...? The stomach problems are a real concern. All this stuff gets so scary. I feel for you.
 
So Lamictal was okay for you and tolerable? Is there anything specific that I might watch for if I switched over to it? I understand our bodies are all different, but it's just good to hear others experiences. I was concerned about the serious rash warning and mentioned it to my neurologist. If not mistaken, I believe I was reading something about "drooling" that you might have posted in a thread.

No rash issues for me on lamictal. The serious kind of rash is extremely rare, but a number of folks do get a regular allergic reaction, especially if the transition is done too quickly or in increments that are too big. The first few months I was on Lamictal I was extra-hyped up -- not a bad thing during the day, but it made for very poor sleep and very vivid dreams at night. My hair was also falling out. Both those side effects went away. Now the things that bother me the most are blurry vision that comes at goes (lots of squinting), and very dry mouth and eyes overnight. No cognitive issues as far as I can tell.
 
No rash issues for me on lamictal. The serious kind of rash is extremely rare, but a number of folks do get a regular allergic reaction, especially if the transition is done too quickly or in increments that are too big. The first few months I was on Lamictal I was extra-hyped up -- not a bad thing during the day, but it made for very poor sleep and very vivid dreams at night. My hair was also falling out. Both those side effects went away. Now the things that bother me the most are blurry vision that comes at goes (lots of squinting), and very dry mouth and eyes overnight. No cognitive issues as far as I can tell.

Blurry vision, dry mouth and eyes doesn't seem extremely harsh. I guess it's easier for me to say until your in the middle of it yourself. Seems as if I've already been experiencing some hair loss as of recent. It's a known effect with Depakote, but I still get some with Zonisamide. Not sure that's age or a combo.

Sounds as if the beginning phases of using Lamictal, as well as any other drug are those that one must exercise some patience before throwing in the towel. Had your doctor warned you of the potential for any of these side effects you ended up experiencing, including any that you did not experience?
 
Yes, the side effects are tolerable, so I'm not rocking the boat at the moment. When I started on Lamictal, My neurologist didn't warn me about any particular side effects. She loves to prescribe it and is a bit in denial about it's potential negatives. When I said that I was having blurry vision and losing my hair, she insisted that I must have diabetes. Which I don't. So I did my own research to see if others put there were having similar issues from Lamictal...
 
I like the denial claim. I'm not an apologist, but I try to see it for what I think they're up against. These neurologist's attempt to treat each patient with one drug or another, having to calculate the side effect/risk benefit factor, there's only so much that could be disclosed in one sitting for each drug. Just look at a warning breakdown.

Perhaps they have to practice acting as if it really wasn't that important to tell you about this or that side effect. Kind of like they always must have to act or, be in a state of surprise. Surely they've learned that patients can only handle so much. Read them the laundry list of side effects and they probably will reject moving forward with transitioning to a new drug. And that new drug may actually control a seizure condition that wasn't under control. However, if I was to hear about this and that side effect, I'd more than likely be a bit reluctant in taking that drug.

I've seen my neurologist display that look of mixed curiosity after I've disclosed the side effects from this past new drug that I previously wasn't aware of. You're not sure what to think, you start contemplating, and again look the doc straight in the eyes and wonder if maybe something is amiss. Your heart rate picks up, anxiety sets in and bit of worry starts to set in. You then break eye contact and start asking yourself, "Am I just part of a Kubrick styled script"? Well, you can't help a racing mind.

Oh well, that's why I'm here and I find these forums so beneficial. Seems as if Lamictal may be a good option. Hopefully there's a better alternative than this Zonisamide.

Appreciate all your input Nakamova.
 
I didn't mind my that my neuro didn't discuss side effects beforehand. Because of the "nocebo" effect, (roughly, if you expect something bad to happen, then it will), I didn't want to hear about all the things that might go wrong with Lamictal. But when I actually started experiencing side effects it would have been nice if my neuro had been supportive rather than dismissive.

Good luck with the Lamictal, hope it can work out for you.
 
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