5 1/2 months pregnant - having problems

[Bella2010]

Hi All,

For four years I took Lamictal, 200 mgs. I did great, no seizures, for those four years. A couple of years ago, I had to take Prednisone for an intestinal condition. I had a seizure shortly after beginning the steroids. While my doc's disagree, I truly think that caused the seizure. We upped my Lamictal to 300 mgs, and things have been great ever since.

When I got pregnant I was so hopeful that all would remain well because my doc told me that if it is well controlled pre-pregnancy, it usually stays that way. Not so much.

At 10 weeks I had two small seizures, so my meds were increased by 100 mgs. Then my doc went ahead and upped them again by 200 mgs. All together, I am now taking 500 mgs.

I had two seizures Friday evening. My doc is increasing me to where I will be taking 600 mgs. total. Hopefully, that will be effective until June when my little boy will be here.

I am just needing to hear positive experience about pregnancy and epilepsy. I am assuming that the recent issues were brought on by increased blood volume because I have never had them around my period before, so I don't think it's hormone induced. So, I am HOPING that I will be able to wean back down after I give birth.

Please, I don't have anyone to talk to about this. I would like to hear other experiences with women who were well-controlled but went south during pregnancy.

I am really freaking out because I am scared I might have one while I am holding my little boy or something. I am just really scared by this.

Any opinions would be appreciated.

Thanks so much!

Beth

[Nakamova]

Hi Beth, welcome to CWE!

I can't speak to your specific issues, but I'm sure the parents here at CWE will chime in soon.

You probably know this already, but Lamictal and estrogen have a complicated relationship that gets even more so during pregnancy, so that may be what is triggering your recent seizures:

Estrogen increases the clearance of Lamictal by inducing the liver enzymes involved in its metabolism. So increased estrogen can lead to sub-therapeutic levels of Lamictal. As estrogen levels gradually rise over the course of pregnancy, the clearance of Lamictal may increase by as much as 200 to 300 percent. Because the Lamictal clearance can differ greatly between individuals, some women might experience a large drop in lamotrigine blood levels during pregnancy while others might see a more modest decrease. It sounds like you're in the former category, and that's why your doc keeps upping the dose.

I hope you get to a stable place soon. here's wishing good health for you and yours.

Best,
Nakamova

[skillefer]

Hi Beth! I'm the proud mom of a beautiful 7 month old baby girl. My control prior to pregnancy was ok...not great. I did have the occasional break through seizure. Mine were grand mals, so I was worried when I found out I was pregnant. My neurologist and I had a plan for if I got pregnant which included making sure that I took 800mcg folic acid every day on top of the prenatals. So I switched meds while pregnant and was put on the new med. During the pregnancy I had a few seizures...3 I think. Each time, when there was a major hormone shift. However, the seizures were no where near as strong as before pregnancy. My neurologist told me that there are risks with all meds. The important thing to remember is that stress will do more harm to the baby then anything else. So, I took that to heart and tried to have as relaxed and enjoyable a pregnancy as possible. Nothing was worth getting stressed over. In July, I gave birth to a 9lb 9 oz baby girl...no birth defects. Afterwards, I was a little iffy about holding her on my own. so, my family decided that until I was comfy with holding her by myself, I'd make sure that I only held her when I was sitting in the middle of the bed, or on the floor...and then only if someone was nearby. You know..so that if they heard an odd noise, they could check on me. After a while I was comfy enough and my blood serum levels were stable enough that I decided that I was ready to deal with holding her all the time. do what you are comfy with. During the pregnancy, my biggest peice of advice is to make sure that you have a support team ready to help out after the baby is here.

[Bella2010]

Thank you both so much for you insight! I really appreciate it.

Skillefer,

If you don't mind telling me, what meds did you switch to during pregnancy? IDK, I doubt I will change since I am half-way through.

The sucky thing with Lamictal is that my doc said they don't check the level in your blood. Does that make sense?

I am trying REALLY hard to keep my chin up on this thing, and I am really trying not to stress out about it. I am SO lucky in that I have a WONDERFUL family support system who have all told me they will be there for me when our baby is born. My sistern lives right down the street, and she has offered to take vacation when baby is born. My DH is also taking vacation, and my mom lives in town as well.

I am just going to try to stay postive for the rest of the pregnancy. We want another child in about 4 years, but this really scares me. On the bright side, at least we will know what to do then.

Thanks again!

Beth

[Nakamova]

I think your doc should reconsider regarding checking the Lamictal blood level. While it's true that there is no single blood serum level that equals seizure control for every person, yours should be within a certain range, especially given the 600mg dose.

It would be useful to see what your blood serum measurement is at trough level (trough level is the low point for Lamictal in your system, usually before you take your morning dose). If the Lamictal is really getting flushed through your system that quickly, it would be worth knowing because that would indicate the probable cause of your seizures. The lack of enough Lamictal could cause seizures, and/or rapid changes up and down in the Lamictal level could cause seizures too.

[Bella2010]

Nakamova,

I think you are right. If my meds are getting way diluted for whatever reason, I want to know so it can be addressed. So, if there's a blood test for this, I think now's a pretty good time to pull it.

I posted a question about Lamictal and blood test over in the Kitchen forum. I will feel more armed calling my doc and calling him out on the carpet about this if I know there actually is a test for it.

I have a monthly check with my OBGYN next week, and I am going to pick his brain about it, too.

Thanks so much for your words of advice and support!

Beth

[skillefer]

Hi Beth! I switched from Phenobarbital to Dilantin. I made the switch at the end of the 1st trimester. The funny thing...my hubby and I found out I was pregnant veeerrry early in the pregnancy. The reason? I had 4 seizures in 4 weeks. So if I have a breakthrough seizure my hubby now asks if I'm pregnant.

Like you, my hubby and I are hoping for baby number 2 in a couple years. Enjoy your pregnancy. That's the best advice I can give. Happy positive thoughts for happy positive baby's .

[skillefer]

Make sure your ob knows you have a neurologist. and what meds and supplements you are taking. My ob had experience woriking with patients with E.