Problems w/ Lamictal and Keppra

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cateyes64

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Good evening. I'm having a problem with recurrent seizures, and I'd like some insight, if possible.
My husband is military, and we're stationed in San Antonio, TX. We were stationed in MD before being transferred to TX. Before we received orders to TX I had a severe seizure with a concussion. With this seizure, my neurologist changed me over to Lamictal. It was a planned change.
When I arrived in TX I slowly began the transfer from Topamax to Lamictal. The entire process lasted a total of six months. Everything was going well for a while, but toward the beginning of 2009 I began having auras. This was new for me. It lasted throughout the year, and ever since then, my epilepsy has gotten worse. With the auras came small fainting spells. They weren't seizures. I had about 4 spells that year. Toward the end of 2009 (Oct or Nov), my neurologist and I decided to add Keppra to see if it would help with the change of seizures. I was okay at first. Then beginning with 28 Jan 2010, my "auras" changed. They were very short in length, and they all began with a slight stuttering. My previous seizures all began with a guttural scream.
The new auras began with a cloudy feeling in my head. It's hard to explain. I then felt a change throughout my body. I felt flushed, and then I began having shivers. These changes lasted anywhere from 20 seconds to 1 minute. I also began having the cloudy feeling in my head. Shortly thereafter I would have a seizure.
I always experienced more or less the same symptoms.
That's when Neurology assumed I was having psychogenic non-epileptic seizures. Even the days I had seizures prior to neurology appointments my doctor would just say I was having psychogenic seizures. She wouldn't even entertain a different cause for these episodes.
I was transferred to another hospital. There was an epileptologist there, and she evaluated my case as psychogenic. She said seizures don't change.
Neurology finally decided to hospitalize me for a 3-5 day EEG w/ video-monitoring Nothing happened the first time. The second hospitalization included sleep deprivation for 3 days. They also decreased the Lamictal by 2/3. On the second day I had a seizure. After evaluating the study, they found out my seizures are epileptic in nature, not psychogenic. Something else, I had partial seizures which secondarily generalize. My seizures are now generalized.
Since the end of Jan I've had 18 seizures. I haven't had 18 seizures in my whole life! The last one was 22 Nov. Since then I've had one blackout. My mom has stayed with me since the beginning of Nov. She's afraid something might happen to me while my husband is away. Heck, I'm scared too. I didn't have an aura with this last seizure.
My seizures have also changed recently. With my previous seizures it took me about 2-4 minutes to "reboot", as my husband calls it. With the last two seizures, 16 Nov and 22 Nov, my mother said it took about 30 minutes for me to "come back". I'm so frightened and frustrated.
The Neurology clinic makes notes of the seizures but nothing else. There's the usual "How are you feeling?" But nothing else. Nobody thinks outside the box. They've also added Vimpat to my regimen. What a horrible medication. Every single time I have a seizure Neurology just adds another anticonvulsant.
I personally think the increased seizures are related to Lamictal and Keppra. Does anybody have any insight on what is happening, or anything else?

Thanks,
Adriana
 
Hi, Adriana! As you can guess, my name is Ann. It's nice to meet you. I can understand your frustration and fright. Your neurologist at the base is not unique. MANY neurologists not only do NOT think outside the box, they don't even bother to open the box to look outside it! sheesh! I can't believe an epileptologist told you that seizures "don't change". Well, they do, as you already know. ;-) I've taken Lamictal & it didn't agree with me at all. I'm currently taking Vimpat & Keppra. I've taken Keppra for a LONG time, (almost 9 yrs) and Vimpat is iffy--it made me so dizzy I fell, but my neurologist didn't return my call for 2 days after I told the receptionists & a nurse that I believed my Vimpat amount was too high.
Now, regarding your concerns, are you just taking vimpat, keppra & lamictal? If so, I'd ask the neuro dept to look into the Lamictal & Vimpat connection. Well, these are my 2 cents. I do hope other CWE members' input helps guide you as to how to approach the neurology dept on base, as well as their ideas regarding the prescriptions you're taking. Take care, Adriana. :-)
 
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Hi, Adriana,

Welcome to the forum!

Thank goodness they finally got your diagnosis right.

Your doc has you on a real drug cocktail. One of the side effects of most of these drugs is increased seizures. The best way to know if one of the meds may be the culprit was to keep a seizure journal. It would show if there is a positive correlation between ramping up on one of your drugs and increased seizures. It's harder to know which one may be guilty now (if any are).

Sometimes seizures just progress. Mine did - exponentially. I have simple and complex partials. Since I was a kid I was having maybe two a year and I just thought it was weird and ignored it. Then in my 40's they really started taking off, up to I think about 5-6 or more a day at one point. Then I definitely couldn't ignore it any more and went to a doctor.

Seizures also tend to get worse over time. Not always, but sometimes. It's not unusual to have simple or complex partials, and then later in life for them to turn into TC's.

Doctor doesn't believe seizures change? I have a different type sometimes, too. Different than my history, anyway. Twice I've had this weird thing when I'm standing. All of the sudden my legs stiffen up perfectly straight and I walk a few steps, like a soldier. I forget what that kind of marching is called. Goose-step???? My doc says impossible because it's coming from a different part of the brain than my seizures come from. A couple of days ago I felt this thing like very heavy pressure around my body. Like a hyperbaric chamber. Weird. I'm not telling my doc about this one. Once I lost hearing, then vision. Everything went black exept I was still awake. It lasted about 5-6 minutes. I was scared silly.

My doc dismisses things that are different. But anything really strange or seizure-like, I know it's a seizure.

Do you keep a seizure diary? If not, keeping one is pretty important. It will help you track and identify possible seizure triggers, seizures, how you feel afterwards, etc. A seizure diary helped me find out that my migraines were postictal (after seizures).

Here's a string with different seizure diary formats:
http://www.coping-with-epilepsy.com/forums/f23/seizure-journals-10776/
 
Its outrageous they said seizures don't change. Sure they do. Mine started with slight feelings of deja vu and progressed until I had one grand mal. Then they started lamictal and and added and removed other drugs in attempts to stop the seizures. The best cocktail, and also worst, has been keppra 3000mg and lamictal 800mg daily. They kept my seizures (complex partial) down to 15-20 a month. However, they make me nauseated, dizzy, and slow my speech. I finally had surgery last June and haven't had a seizure since. I'm still on the drugs, but they let me drop the Keppra to 2000mg this week as the beginning of a two year reduction plan. I can't sleep now, but I expect that to improve. I can't wait to get off Keppra!
Don't let your doctor dismiss what's going on with you. Be assertive and insist that they listen to you rather than jumping to conclusions. You're the one who experiences the seizures, not them. I also believe you should start a seizure diary. I used to take mine with me to my neurologist appointments. It helped both me and the neurologist analyze the situation.
Hang in there, and good luck!
 
Hi cateyes64 --

You've had some lousy neurologists, that's for sure. As noted above, many of the things you were told were completely wrong. It is very possible that some your meds are making things worse. While some people do control their seizures with multiple meds (polytherapy), the standard protocol is to try meds singly (monotherapy), rather than to keep tossing more into the mix. Is there are any chance you can see another neurologist, or get help from a different epilepsy center? It does sound as if your seizures are progressing, so it's important to get a handle on what's going on. In the meantime, do your best to avoid anything that might be a stressor -- fatigue, alcohol, caffeine, infection, dehydration, etc.. Go easy on yourself and give yourself time to recover from any seizures.

Best,
Nakamova
 
i am a cna with the same head injured person since 1987 .that person has been givin keppra with the best success . caffeine and the stressors Nakamova metioned are to avoid . meditation is a stress reducer .as for your mom she is there while you seize, and she may do what i have done. i improve the breathing by applying a breathrite strip as directed on the box. i believe that the lack of air is a major problem at the time of a seizure.i even go further to help breathing but i am nervous to speak about it as i am a cna and while i have been in the world of siezures with my client for 20 years. well it is just me .
 
new coctail

hi i have only started have seizure for the past 5 years. i am still being treated as a guiny pig. i have been on vimpat 500mg and lamictal 200mg a day. my doctor just had me do a 72hr eeg, and saw that my neron were abnomal , so he is wanting to add keppra 1,000 mg a day. i am scared about what will happen because my brain is very sensitve to what i take, and have had tons of side effects with them. i am looking all over the internet to learn about keppra and the mix..if any one can help i would be very gratefull.

KAte
 
Hi kate --welcome to CWE!

I would be wary of adding a third medication to the mix. As you say, it's hard enough dealing with the side effects of one or two. Are you experiencing actual seizures currently, or is your doc only responding to the EEG results? If your seizure are currently controlled, you could make an argument for staying put where you are. If they aren't controlled, any reason your doc won't just up the Lamictal? 200mg/day is a relatively low dose.

Keppra works well for some folks but not for others. It's well known for causing mood-related side effects (especially "Kepprage"). If you're at all vulnerable to mood issues, you might want to consider something other than Keppra. And if you're not comfortable or confident with your neurologist's advice, you might want to get a second opinion.

Best,
Nakamova
 
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