Medication-induced seizures in Daughter with DS

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Marlene

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Heather, my daughter, is forty-three years old and has Down Syndrome.
After a long hospitalization, two years and nine mos. ago, Heather developed involuntary-movements and had t/c's due to taking a drug--Ativan, a benzodiazepine which causes more gaba-action in the brain. After 18 mos., during which she developed involuntary-movements, had several t/c's, lost the ability to walk without assistance, to speak, and basically went from a being high-functioning person to full-care, it was finally discovered that the Ativan had caused the problems. She was given the prescription for Ativan as she was leaving the hospital after the long stay for pneumonia. When I asked what it was for, the doctor said that because she had been away from home for such a long time, if she had trouble sleeping to give her one of the "little anti-anxiety pills." On the third day after returning home, she developed gas pains and had trouble sleeping and I gave her one of the pills. The next night she had trouble sleeping, and I again gave her one of the pills. The third day after taking the first pill, she had an involuntary movement. She had never in her entire life had even a tremor. I phoned her primary care doctor and she said to give her more of the Ativan, that it was used to treat involuntary movements.
Months later, when it was discovered that the Ativan had caused the movements, she was slowly withdrawn and all involuntary movement eventually left. She regained her confidence that she would not 'jerk' and fall if she stood without holding onto someone and she began to walk again without assistance. She began to regain all functions she had lost due to the Ativan.
Unfortunately, in May she developed a uti and was given a drug that contained sulfa. She had an anaphylactic reaction and was a code-blue with anaphylactic pneumonia, was on a ventilator for 12 days and was given many fluroquinelone antibiotics. They interfered with her CNS and the involuntary movements returned. Four months later they are still with us, though not as frequent. The cessation of involuntary movements she had due to the Ativan was predictable. In almost all cases benzodiazpine-induced movements and seizures cease when the drug is withdrawn. However, from reading, I am not certain these fluoroquinelone-induced movements ever will stop. I will appreciate any knowledge anyone would care to share regarding situations similar to our daughter's. I am particularly fearful of SUDEP, since she is a heart patient. She does not take AED's, since both neurologists, one here in our hometown, and another who saw her at Vanderbilt said that she does not have E and that AED's can do more damage than good if given for undiagnosed E. I will appreciate any information anyone will share.
Thanks,
Marlene
 
hello and welcome....
I just wanted to say that I am sorry for all you have been through with your daughter. I really don't have any answers to you specfic questions, but I am sure someone else here will.
wishing you the best. :)
 
Hi Marlene, welcome to CWE!

You and your daughter have had a rough ride with the meds and the side effects. I hope things get better from here on out. I understand your concern about SUDEP -- it is scary, especially given that there is not a lot known about how, when and why it strikes. What they do know is that it is relatively rare. There are certain risk factors: being male; African-American; being of young age at seizure onset and having a seizure history of over ten years; using alcohol or recreational drugs; nocturnal seizures; uncontrolled generalized seizures; multiple AED use. These are just statistics of course, but I do think they suggest that your daughter is at low risk for SUDEP. You should talk to her doctors about your concerns about her cardiac health, as well as how to proceed in terms of treating the involuntary movements. Have they suggested a course of treatment to help with the movements?

You might want to ask about neurofeedback, to see if it might be of help in your daughter's case. There's more info here: http://www.coping-with-epilepsy.com/forums/f22/eeg-neurofeedback-501/

Best,
Nakamova
 
Thank you Daisy and Naka.. for replying. Having read previously some of the things listed as risk factors for SUDEP is the reason I have never pushed for her to take meds.. In every case that I have read regarding SUDEP, the individual was taking multiple AEDS. Since this latest insult from the fluoroquinelones, she has not walked without assistance. Prior to the fluoroquinelones, she had regained her confidence and was beginning to walk short distances without assistance. Our hope is to get her back to that point, and I doubt if she ever would if she took meds that made her feel dizzy. Almost every side-effect list for AED's state that dizziness sometimes occurs. Thank you for replying to my post. I look forward to learning a lot here.
 
My daughters seizure control became much worse when taking meds. What has made positive improvements in her health as been making nutritional changes. Making very careful food choices has made the quality of her life return to normal.
 
swallowing difficulty

One of the more challenging issues regarding daughter's diet change is the muscular issue she is still recovering from due to the Ativan. Swallowing involves many muscles and, although her cough response has improved and she has begun to swallow more strongly, she is still at risk of aspiration. Looking for foods without additives that meet the criteria of the dysphasia mechanical-soft diet is proving to be one of the more challenging tasks associated with her dietary changes. Anything grainy, even brown rice, is not good. Although their nutrition is not so preserved as fresh, canned foods like asparagus that contain only the veg. and water work. They 'smush' easily. I do better at WF Mkt., but unfortunately it is a 2 1/2 hr. drive from where we live. I'm trying to find a good multi-vitamin that is gluten-soy-iron-and phenylalanine free. Any suggestions will be appreciated.
 
So Sorry for all your problems, It's hard no matter how old our kids are.
Your daughters response to Ativan was unusual, so it could have been considered allergic , becareful she does ever get them again.
Continued success in her recovery.
 
Hi Marlene,

My son (11 now) had serious withdrawl reactions including seizures when we weaned of clobazam (at age 5-6), which is another one of the nasty benzos. We managed to get him seizure free for a long period on the ketogenic diet, we weaned off all AEDs and the clobazam -used for more than 3 years- was the last med to get rid of. It was the most difficult one, each time we reduced the dose, we saw nasty withdrawl side effects and seizures breaking through the diet for several days. When the clobazam was out of his system, he got stable again.
I found this one http://www.benzo.org.uk/manual/bzcha03.htm a very useful website about the benzodiazepines (including lorazepam)
This link opens on chapter 2: acute withdrawl symptoms and how to withdraw.
Chapter one is about what the benzo's do in your body including side effects http://www.benzo.org.uk/manual/bzcha01.htm
 
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I agree they are addictive in nature , but if you need them to function you are not an addict. It is no different with Anti depresants or anti-psycotics There hell never leaves!
Any substance that the brain needs will cause a withdrawal type reaction.
And if he were to go into status, they would have to probably use benzo's again.
 
The "key" here is my daughter's Down Syndrome. Due to their Trisomy-21, an extra chromosome, which causes DS, persons with DS are born with 30% more GABA than they have neuro-receptors to handle. Benzos create more gabe-action in the brain, so, in layman's terms, to give Ativan, a benzo, to a person with DS is like opening a Hoover dam of gaba into their brain, and they can cause seizure. My daughter was particularly super-sensitive to it. Over the many months she took the medication, it impacted her entire neuro-muscular system. Some persons with DS may be able to take it on a very short term bases.
Sandi, you're correct about 'status;' a benzo is used for 'status.'
Our situation is the classic example of why everyone should investigate every med. any doctor prescribes. Thanks to all for replying.
 
benzos are the whole reson i have general epilepsy.
the doctor cold turkeyed me off 8 mg klonopin 5 days later i have a stroke and get banged up real good from the ensuing grand-mal and nearly die from rhabdomyolysis after being unconscious 3 days i can't walk now either .
this really blows.
 
Marlene, TBI ,and Autistic patients are super sensitive as well.
My loading dose is only .25mg relative small. Max dose 1mg. or I am comotose- I have only twice had to go that amount.Usually I suffer first.
I have the feeling that is Why I can't get to effective dose on meds. I think it's a direct result of the brain injury.
Ian so sorry you have been injured, Your
Dr should have known better.
 
benzos are serious drugs they pass them around, then withold them like it's no big deal even though that can easily kill, or maim in my case.
it just blew a whole in my brain because my bloodpressure was all over the place i was totally unaware of it.
that caused generalized epilepsy, the stroke that is.
i still take pretty large doses of klonopin or i get the tremors.
and i appreciate the sympathy, sandy; the world is an very unsympathetic place to live in.
no doubt he should have known better having practiced 29 years.
 
Quote from one of my former posts about benzo's:

The benzo's can be very effective in stopping seizures but usually in a transient way, unless the dose keeps on being increased as tolerance to the drug occurs. For that reason they are best kept for emergency meds for prolonged seizures.

The benzo's act as a 'top up' to the GABA in the brain, a neurologist inhibitory chemical, meaning everything is 'subduced' when the GABA level is increased, including seizure activity. But the tolerance aspect comes about when a compensatory mechanism starts occuring, that is -due to the regular artifical top up- the body starts to produce less natural GABA, meaning the overall level drops down again, requiring another med increase to keep the status quo, the natural GABA drops down again, another med increase is required, and so on...

Apart from the tolerance problem if using them as regular anti-epileptic drugs, the benzo's can become less effective in an emergency situation, as the brain is already 'used to' this class of med, and so a lot more is required to have the same effect.

Weaning of benzo's which are used on a regular base can be awful, which is also tied into the GABA levels. As you reduce the dose, the GABA levels drop down below what they were previously; the brain is in a neurologic excitory state, and so the seizure threshold is lowered until the natural GABA production kicks back in once the brain releases it as a shortfall. That is when they (hopefully) stabilise. And then you do the next reduction, go through it all again, and so on.

Three years we've been adding/reducing/weaning benzo's (mainly clobazam) in combination with valporate and several 3rd drugs. When the ketogenic diet appeared to be effective, we had no problems weaning of the current two anti-epileptic drugs. But weaning of clobazam took us 6 months, a dramatic process. We were weaning of 10 mg with only 0,5 mg per 3-6 weeks and still he was having breakthrough seizures for a week each time we weaned of 0,5 mg.
 
the rule of thumb is 1% dose reduction per day and that's best done with liquid titration methods.
as stated the problem is downregulation of gaba receptors and it takes a long time sometimes to upregulate those receptors again.
which is why i can't stop taking benzos and i've been on them 6 years at least.
 
Thanks for replying. Ian, your story breaks my heart. What happened to you sounds so un-necessary. I've never had a seizure, but watching my daughter have them has been the most terrifying experience in my life. She was doing very well recovering, had even started to walk again without assistance. Then she had the anaphylactic reaction to Bactrim and went into pneumonia. The fluoroquinelones she was given for the pneumonia brought back the seizure activity. The seizure activity is less frequent now than when she first came home from the hospital. We look forward to the day when all the receptors have reset and hopefully no more seizure.
 
glad to help, a question; has your daughter been given an examination by a nuerologist to confirm epilepsy, and started aed treatment?
the thing about seizures is one begets another, it's reffered to as the kindling effect.
so if not properly addressed it is possible the frequency of seizure activity may intensify.


disclaim
not to be construed as professional advice.
 
One of the more challenging issues regarding daughter's diet change is the muscular issue she is still recovering from due to the Ativan. Swallowing involves many muscles and, although her cough response has improved and she has begun to swallow more strongly, she is still at risk of aspiration. Looking for foods without additives that meet the criteria of the dysphasia mechanical-soft diet is proving to be one of the more challenging tasks associated with her dietary changes. Anything grainy, even brown rice, is not good. Although their nutrition is not so preserved as fresh, canned foods like asparagus that contain only the veg. and water work. They 'smush' easily. I do better at WF Mkt., but unfortunately it is a 2 1/2 hr. drive from where we live. I'm trying to find a good multi-vitamin that is gluten-soy-iron-and phenylalanine free. Any suggestions will be appreciated.

I personally wouldn't waste my money on a multi vitamin. I would target some of the key issues where you can tell she is deficient, or what your testing tells you she is. Many of the companies make powdered form or it can be cut into smaller pieces.

I want you to talk to a man that was able to recover his child from neurological damage. His contact info can be found on his website:
www.stankurtz.com
He even created a Vit B12 lollipop for the kids
His son had dietary issues in the beginning. You can see this from the recovery videos on his site. Take a look at it, and give him a call. He has been willing to offer great advice to many people in similar situation as yourself. Worth a chat anyways.
 
glad to help, a question; has your daughter been given an examination by a nuerologist to confirm epilepsy, and started aed treatment?
the thing about seizures is one begets another, it's reffered to as the kindling effect.
so if not properly addressed it is possible the frequency of seizure activity may intensify.


disclaim
not to be construed as professional advice.
Ian: Daughter has seen neurologist here, and at Vanderbilt. She has had 2 eegs and 3 ct-scans, none showed any reason for seizure. Both neuros said that they would not prescribe AED. She never even had a tremor prior to taking the Ativan, and when she was withdrawn all involuntary movement stopped. It began again when she had to have so many antibiotics to treat pneumonia.
Robin: Thank you. I will go to web-site you listed.
Thank you.
 
Robin, What does 'chelated' mean when referring to supplements? I see this term used frequently and I do not know what it means. Is it superior to supplements that are not 'chelated?' Magnesium, Zinc, Folic..., are supplements that have been identified as being deficient in persons with DS.. Thanks, Marlene
 
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