What does this lab result mean?

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lindsayschu2

lindsayschu2

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So I got my blood work back, and for the first time I'm finally considered within therapeutic range of Lamictal and Topamax. But still I'm having seizures. So what does this mean? How much higher can a person go than the therapeutic range, if at all? My GP said i have some range to go higher still and I'm at the lower end of therapeutic, but if I'm at therapeutic and it's not working, does this mean these are not the right drugs for me? Of course there's that good possibility I'll never get rid of seizures. I'm only on 250 mg of Lamictal, and lots of people are on WAY higher doses. I'm confused.
 
You should still have room to increase and stay in "theraputic range". If you hit that limit, you'll have to move on.

Have things improved at all with the combo?
 
My doc says it's all about the serum levels. I'm on 750/day Lamictal with a serum level between 12-14 (can go a little higher) and 3000 Keppra/day with a level of 15 (never really seen a range for that one). I've only had 4 szs, the last a few weeks ago at these doses. It's so individual, it's as much about control of the szs as what your levels are, and what combos ultimately work for you. Good luck.
 
I called the office back and got my numbers, then looked up the ranges. It looks like I am at the very lowest of the wide ranges for both meds. I'm at 4.5 for Lamictal (ranges I found start at 4), and 5.0 for Topamax (ranges I found start at 5). Both go a lot higher and I'm just barely over therapeutic range, and they took my blood at what would have been a reasonably high level of the day for me. Things improved for a while but the last two weeks have sucked. I'm trying to stay positive but I'm not doing a very good job right now.
 
When I first started I was between 6-8 and it wasn't being helpful. I'm sure your doc will work you through it to find that right place for your body. It's more an art than a science I'm afraid.
 
Reaching the therapeutic range does not mean it works or doesn't just because you've reached a range.

Being at the bottom of the therapeutic range means that your levels are high enough that they might be helpful but if not, you can still raise your levels until the drug does help or until your levels reach the top of the therapeutic range.

Below the therapeutic range means that there is not enough drug in your blood to have an effect (though there are exceptions) and above the therapeutic range means that the drug either stops being effective or the likelihood of side-effects/negative reactions outweigh the benefits.

Like Bluecat said, it's usually measured by the concentration in your blood, not by how many milligrams or pills you are taking.

Hope that makes it easier to understand.
 
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Ok so another question: Has anyone here been at a therapeutic level of a med and still had seizures, increased the dose, and become actually seizure free? I'm just wondering if I'm still having seizures now at this level if I'd better be resigned to the fact that I may reduce them further but will have to live with them forever. Being refractory is new to me and I'm not taking it as gracefully as I could I suppose, and really am not ready to accept it. I had 17 years of complete control and it seems like that may not be the case going forward.
 
Thanks Epileric, I was typing my whiny message at the same time as you. I may not have whined so much if I saw your message first (or, I may have) ;-)
 
lindsayschu2 said:
Thanks Epileric, I was typing my whiny message at the same time as you. I may not have whined so much if I saw your message first (or, I may have) ;-)
Click to expand...

No problem. I'm glad I've made things a little bit clearer.
 
I am/have been on both medications. My neuro always had my blood drawn at the lowest point (the trough). I would have my blood drawn first thing in the morning... right before I took my meds.
 
They never asked me when I last took meds, so that didn't factor in. I really think I'm below range in the am (or at least below anything that works for me for sure) since that's usually when I have breakthroughs.
 
I'm always told to do it at the trough (I have it drawn just before my evening meds (5'ish)
 
@lindsayschu2

General practitioner? Why not see a specialist like a neurologist or an epileptologist? They can do a lot better job than a general practitioner as they specialize in these fields.

I'm not quite sure regarding the blood levels. When you are on a generic version of medication it can be anywhere from 80 to 120% read http://gabionline.net/Generics/Rese...eptic-drugs-bioequivalent-to-brand-name-drugs

You really need to see a specialist, perhaps even change medications.
 
My last neuro has made a lot of mistakes, the most recent was giving up on me and saying he didnt know what to do, though I've only tried the med I've been on for 17 years (without trying to increase it from a very low dose and non-therapeutic levels) and the two I'm on, which he didn't feel we could increase, though there are many options out there. He basically gave up on me and got off the phone. I'm not going back (would you?) I have an appt with an epileptologist at the best neuro practice in the state on May 28, and I'm holding out until then, using my GP as a backup for basic stuff until then. Thanks notime!
 
I agree with notime that a GP isn't appropriate at all for this. Glad to hear you got an appt for the 28th. Do let us know how that goes, and I hope it goes well.
 
lindsayschu2 said:
My last neuro has made a lot of mistakes, the most recent was giving up on me and saying he didnt know what to do, though I've only tried the med I've been on for 17 years (without trying to increase it from a very low dose and non-therapeutic levels) and the two I'm on, which he didn't feel we could increase, though there are many options out there. He basically gave up on me and got off the phone. I'm not going back (would you?) I have an appt with an epileptologist at the best neuro practice in the state on May 28, and I'm holding out until then, using my GP as a backup for basic stuff until then. Thanks notime!
Click to expand...

I don't blame you in the least for bailing on your last neuro. I sure wouldn't go back. What occurred to you is reminiscent of what happened with my first neuro. I'm now with an epileptologist, and the focused care I am receiving is like night and day compared to the first one. If your GP is very familiar with your health and trusts your judgment, I think you're fine to wait until May 28. If my experience is any indication, the epileptologist will change everything up anyway!
 
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