Return of simple partial seizures after 9 months on Lamictal

[Ramjet]

This weekend I had a return of my sweating events which are apparently caused by simple partial seizures. I have been on a 500 mg dose of Lamictal (extended release) for about 7 months, which had eliminated 95 percent of the individual episodes. I was having 10 - 20 episodes during what I have referred to as an event, which would last about 24 hours and then be repeated about 28 days later. Since being on the Lamictal I would have maybe 1 episode every month.

The event this weekend included 12 episodes.

Questions for the group:
What is the highest recommended dose of Lamictal?
Is it likely they will want to increase the dose level, or try me on another medication?
I see online that Lamictal is also used to treat ADHD and ADD conditions. Has anyone here experienced changes in their behavior or mental condition that could have been related to taking the medication? Are there things in this area I should look for?

I suppose it is possible my seizures have entered a new phase which can't be controlled with the current medication or dose level.

Regards.......Dick

 

[Nakamova]

Hi Dick --
I'm sorry to hear about the uptick in your seizure activity. Any chance that it's related to a specific, one-time trigger, like missing a dose or being unusually stressed?

There is no specific dose for Lamictal, since the therapeutic level is highly individualized. Generally 300-500mg/day is considered the "standard" range, but there are plenty of people who fall on either side of that range. My seizures are controlled at 150mg/day; I've read of others who require 800mg/day. Your neurologist may suggest an increase in dosage for you, but since side effects would tend to increase as well, you would need to closely monitor how you feel.

Lamictal isn't approved for treating ADD/ADHD, so not much is known about the results of such usage. Generally speaking, all the anti-seizure meds can potentially have powerful effects on behavior or mood. If you feel that Lamictal has affected you negatively, let your neurologist know -- it may be a good reason to try something else instead.

 

[PSUgirl2009]

Unfortunately, I can only answer one of these questions, but I hope this helps:

The maximum recommended dosage of Lamictal is 1600 mg/daily.

 

[Ramjet]

The neurologist upped the dosage to 600 mg. I have enough of the 200 mg and 100 mg extended release tablets to last a month before my mail order pharmacy will ship the new dose level (I told them to hold off a month).
I have not missed any doses. I lay them out each night and take them he second thing I do in the bathroom in the morning.
I have had some episodes of double vision while on the Lamictal and was told to eat small snacks during the day so that I always had something to reduce the absorption rate of the medication.

 

[jemsister]

I haven't experienced any mood changes with Lamictal, and very few side effects in general. I had double vision at first, for maybe a couple of weeks? But this went away. I always take my pills with food, so I think it was just my body adjusting to the new med. Currently, I'm on 400 mgs/day, but they plan to go up as the bring down my other meds.

My neurologist told me that finding a therapeutic dose has more to do with the blood level than how many mgs you take, because people absorb medicines in different amounts. So when I am having an issue, the first thing she always does is order a trough level. I tend to have low absorption and a super fast metabolism, so I have been on pretty high doses--doses that many people my size/weight wouldn't tolerate.

She is the first neurologist I have ever gone to who manages my dose this way. The rest just did guesswork on it.

 

[Ramjet]

Thanks. What is a trough level test and how is it done? Does it look at the medication level in the blood to look for peaks and valleys over 24 hours?

 

[Nakamova]

A trough level test is a blood test taken when your medication is at its lowest -- right before you take your next dose. The amount of the med shown in your blood serum at that time is when you are least protected. If it is below what is considered a "therapeutic" dose, then your neurologist may increase your dose to make sure you will always have enough in your system to provide seizure control.

However, some folks (such as myself) can have very low blood serum levels and still have consistent seizure control, while others can have very high levels and not have consistent seizure control, so the neuro needs to be sensitive to individual variations in medication response while making dosage recommendations.