Long time, no seizures

[jamesw]

Hey folks,

I just looked and it's been a few years (!) since I last visited these parts. I'm coming up on 3 years since the tonic clonic that almost killed me (okay, it was the head injury immediately after the seizure that almost killed me). I spent most of that time seeing a neurologist who never conducted another EEG after I left the hospital, who didn't seem concerned that I thought I might be having partial seizures, and who had no interest in adjusting my meds. (And I was so freaked out by the whole epilepsy/TBI thing that I wasn't great about self-advocacy.)

Last summer, I found out that my small town has an epilepsy clinic, and I couldn't switch over fast enough. Since then, I've had 2 EEGs (including a 72-hour ambulatory EEG, boo hiss), my Keppra dose has been almost doubled, and I have actually been told that I have temporal lobe and occipital lobe epilepsies. (I was also told the extent of my head injury, which my former neuro never bothered to share.) It is so incredible to finally have a neurologist who treats me like a human being who can understand my medical issues.

So I've been mostly seizure free since I reached 3500mg Keppra/day a few months ago. BUT, I have been experiencing major depressive episodes (I'm already prone to depression). My neuro is so pleased with the seizure control that he asked my GP to try out different antidepressants -- so I've been running through that list. I know AEDs can increase potential for depression, and so at this point it seems like it's a matter of choosing between depression and epilepsy. How do you make a decision like that?

I'm not due to see my neuro for another month, but I'm curious about what kinds of questions I should ask. (Ok, I'm still not great at self-advocacy.) Is it time to request switching seizure meds? I've heard the VNS has some effect on depression, but I don't know how my epilepsies might play into that possibility. Are there other options I don't know about?

I appreciate any input y'all might have. I expect I'll be poking around here more often.

 

[Nakamova]

Hi jamesw,

It's great that you've found a neurologist that you like -- sometimes that's half the battle. And it's great that Keppra has been pretty successful for you. Now here's the tough thing -- more than any of the other anti-seizure meds, Keppra is associated with mood-related side effects, including depression. I'm sure it's not an easy decision, but my vote would be that you at least discuss the possibility of trying another seizure med before adding an anti-depressant to the mix. All of the brain meds are tricky, and some of the anti-depressants can potentially lower seizure threshold, so if you decide to try one make sure that it's one of the newer kinds that is safer for people with epilepsy. You might be interested in these links: http://health.usnews.com/health-new...ead-to-fewer-seizures-in-people-with-epilepsy
http://www.uspharmacist.com/content/c/37593/?t=alzheimer's_and_dementia,neurology

I would also recommend that you keep the VNS as a last resort as this point. CWE members have had mixed success with it -- for some it's great, and for others it's been a mistake -- so as long as your seizures seem receptive to medication, keep implant surgery low on the list of treatment options.

Some CWE members do take anti-depressants with seizure medications. I hope some of them will chime in, but in the meantime, below are links to CWE threads on the topic:
http://www.coping-with-epilepsy.com/forums/f23/antidepressant-use-keppra-14912/
http://www.coping-with-epilepsy.com/forums/f23/best-worst-antidepressants-20220/
http://www.coping-with-epilepsy.com/forums/f23/aeds-anti-depressants-23885/
http://www.coping-with-epilepsy.com/forums/f23/questions-about-prozac-7111/
http://www.coping-with-epilepsy.com/forums/f23/my-wifes-seizures-zoloft-link-6632/
http://www.coping-with-epilepsy.com/forums/f23/seizures-major-depression-24724/

Cheers!
Nakamova

 

[valeriedl]

The VNS can be used for depression. I read a few web sites of the VNS being used for depression alone and most say that you have to have tried at least 3 different depression meds and have had no reaction to them before they suggest the VNS. Your depression has to be so severe that you are suicidal before one is suggested too. A side effect of many seizure meds is depression also.

I don't know how it would react if you have epilepsy and are using it for depression. Your epilepsy meds/dosages may have to be changed which could possibly cause the frequency of your seizures.

I have a VNS to help with my seizures. I've never had problems with depression before or while I've had epilepsy so I can't really give you any advice on it working for that. I do take Keppra and have very bad anger issues, Keprage, from it. I don't think the VNS helps with that at all for that.

 

[jamesw]

Thanks Nakamova! This is all really helpful info. I've cycled through about 3 or 4 anti-depressants in the last couple years, to no avail. My current neurologist seems to be the type who, having found a successful AED, isn't going to be easily convinced to switch it out. But, considering my depression levels in the last 6-9 months, it's probably time to start convincing him. Fingers crossed!

 

[Dignan]

I'm with Nak on the look at other seizure med idea. I know it is difficult to make that decision, and perhaps you want to give it time to think about it, but if you could find another drug that didn't cause depression and still controlled seizures that would be ideal.

I am an advocate of taking as few meds as possible, since you open yourself up to more side effect possibilities with each drug you add on to your regimen.