Tolerance to Tegretol?

[iceman]

Welcome everyone,

I do realize that this topic has been already discussed here several times, but nevertheless I would like to hear your opinions. Before I I describe my problem/question, let me quickly describe my epilepsy history.

I had my first seizure in December 2010 when I was coming back from a house party. I was sober at that time, but It is worth mentioning that I had the worst hangover in my life and also I hit myself in my head at that party. I had my seizure in a public place and I was taken to the hospital by ambulance. After spending the night in the hospital the doctor has decided that most probably it was only a single-seizure caused by excessive alcohol consumption and released me home.

I was happy seizure-free for another 6 months, and then in June 2011 I had three seizures in a row. That's when my doctor decided to put me on Tegretol (2x400mg). This worked very well - I was seizure free for another 4 months, and I had a seizure in October 2011 just because I forgot to take my medications. After that failure I started really paying attention to my medications.

I was seizure free for almost 2-years and then yesterday I had another seizure at work.. (even though I didn't miss my medications).. I was therefore wondering if anyone here had similar experience and if yes what could be the possible cause? Did I develop tolerance to Tegretol?

What do I need to do now? Increase my dose or completely change my medication?

stay cool

 

[Nakamova]

Hi iceman, welcome to CWE!

There can be several causes for a breakthrough seizure after a relatively long period seizure-free. It could be related to an unusual one-time stressor (fatigue, infection, illness, dehydration, food allergy or insensitivity, etc.). It could be a sign that your metabolism is changing, and you may need a slightly higher Tegretol dose to provide a "safety margin". It is also possible to develop a tolerance to Tegretol, although it's more likely to occur after a few months, rather than two years.

Unfortunately, there's no way to know for sure what's going on in your particular case. If you can rule out the role of an unusual trigger for your seizure, then your best bet is to talk to your neuro and discuss any next steps. If Tegretol has been a good fit otherwise (in terms of side effects), you might want to go the conservative route and merely increase your dose. If you've lost faith in Tegretol, then your doc can tell you about other meds that might be appropriate.

Your best bet is tot alk to your neuro

 

[iceman]

Nakamova,

Many thanks for your prompt and concise reply - it really explains a lot. The day before my breakthrough seizure I went hiking - I did around 14miles in the mountains, ate almost nothing. On top of that I was on antibiotics for skin infection (Flucloxacillin) at that time. When I came back home from the mountains, I felt really cold so I also ate some standard paracetamol pills and didn't get much sleep at night... So yeah.. It might seem like I'm just trying to find the trigger you have mentioned, but it really all makes sense now..

 

[Nakamova]

While paracetamol (acetaminophen/Tylenol in the U.S.) is generally well-tolerated, it specifies that it is to be "used with caution" in people with a history of seizures, and is "not to be used by" people who have a history of uncontrolled seizures. Probably not a factor unless you have reacted poorly to it in the past. Still, it may have contributed to your breakthrough seizure, perhaps in combination with low blood sugar or dehydration from your hike. Sounds like you should be okay staying on the Tegretol, but you should let your neuro know -- and consider upping your dose if you tend to do a lot of exercise that may stress your system.