too much meds

[msuder0583]

I was wondering if this was too much meds. Cause the side effects are nuts. I am in college for elementary education and of course my doctor wrote me off so I could get a refund. Was wondering if I should take her up on it? Right now I'm on 400 mg of topamax, 600 mg of lamicital and 1750 mg of keppra. Hell, it was a pain just typing this. I just needed a third party suggestion, cause no one without epilepsy will never understand. No matter what they say. Just any help will help. The main problems are my my motor skills. But they make me happy and have stopped my seizures completely. Which is so important to me. Gives me peace of mind. Please help.

 

[Endless]

Msuder,

Welcome to the forum! I am glad you are here. This is a great site that has given me the support I needed to get through all of this.

I agree. The meds can make our brains pretty mushy. I also understand the problems balancing the choice between meds with seizures. It's so hard to get it right.

I assume your doc knows the meds make you feel this way? I understand his thinking on so many meds - he wants to stop the seizures. Cold. That's because even a few seizures can lead to more seizures, and make it all harder to control. I also really understand your thinking - sure, the seizures are controlled, but we need to be able to function and have a life, too.

Did your doc add these meds incremetally (one at a time, increasing the dose slowly)? This would have resulted in the least possible amount of meds to control your seizures. If he added them all at once it's pretty hard to tell if fewer types of meds or a lower dose would have done the job.

How long have you been on this mix of meds? Has your body had time to get used to them? Sometimes the side effects get better over time, sometimes not. For some people it takes a couple of months, for some people a couple of years.

I'm just so, so sorry you are going through this. Hang in there. It's going to get better.

<<<<hugs>>>>

 

[Nakamova]

Hi Msuder --

I know it's great when you find THE combo of meds that will give you seizure control. But if the side effects are a dealbreaker, ask your doctor about backing off the dose(s) slowly to see if you feel any better and still have seizure control. I don't know if you can tell which med is the most problematic. They affect everyone differently, but *in general* Lamictal is supposed to have the fewest cognitive side effects. Topomax is known as "Dopomax", and its reputation is less than stellar. Keppra is known to affect mood -- don't know if you've experienced that. The kinds of seizures you have may make a difference too for what meds a remost effective. Your neurologist should be able to help you. figure what steps to take. With any of the AEDs, tapering down should be done verrrrry slowly to minimize withdrawal side effects.

Let us know what you and your neuro decide.

Best,
Nakamova

 

[Kah]

In the past....

I've been over medicated. And there were several twitches and tremors I experienced due t this. All that sounds like alot to me. Over medicated can be just as bad as not being medicated. I dunno what your exact situation is. When I found myself being over medicated, I felt what I can only describe as tingling but its wasnt even that, but that feeling made me literally writhe on th floor. I suppose it felt like growing pains but instead of bone its a nerve "hurt." When I would lay down t fall aspleep, I'd have trouble even sleeping. at the time I was on 8 diffent meds all of which were extremely high doses. I'd lay down and twitch and toss and turn(writhing), and sigh alot as I was kinda agitated. when I say twitch the movement was accompanied by a shock or an electical feeling in the area of th twitch. Once I was backed off all th meds all that stopped.

 

[msuder0583]

thanks

thank you all so much for the quick replies. it was a huge help. in fact i just woke up from a 13 hour sleep. at least i won't seizure from lack of sleep. i actually talked to my neurologist yesterday and she told me about two weeks but this is a pain. i hate feeling this way. she said the topamax or the high dose of keppra is the one causing it since its the introductory drug (i've never taken it before). but since i used i've used drugs in the past it almost seems worth it to sacrficie that for seizures, but i thought that part of my life was over. oh well. i am going to see my neurosurgeon at johns hopkins this week, and i am hoping he will either want to drop my meds or maybe substitute. and i am sorry to hear about everyone's situation. but once again, thanks. you guys were more helpful than my doctor.

 

[Dutch mom]

Sometimes less medications instead of more seems the better treatment, especially for children with intractable epilepsy.

http://jcn.sagepub.com/content/22/1/15.abstract

There is evidence that decreasing the number of antiepileptic drugs in patients with intractable epilepsy can in fact have a beneficial effect on seizure control.
In a recent study by Chen et al, the number of antiepileptic drugs was decreased in 29 patients from a mean of 3.6 to 1.9,
which led to improvement in 65.5% of patients with no worsening in 96.6%.15 Is it rational to add antiepileptic drugs serially?
This question needs further investigation

Reinvestigation and Reduction of Polytherapy in Children With Chronic Seizures

Abstract
From October 2001 to October 2003, the authors reviewed all patients with chronic seizures taking antiepileptic drugs for more than 2 years with follow-up at the pediatric neurological clinic. They identified 31 patients who were using 3 or more drugs. Twenty-nine patients agreed to undergo a drug reduction and readjustment. The authors spent a mean period of 14.1 months to either purely reduce the numbers of drugs or introduce a new drug (rational polytherapy) plus removal of some drugs to achieve the end goal of a maximum of 2 or 3 drugs (if necessary). Seizure control in 96.6% of patients (28 of 29 patients) did not worsen after the readjustment and reduction of the antiepileptic drugs. Instead, 65.5% (19 of 29 patients) got better, and 37.9% (11 of 29) were seizure free. The number of antiepileptic drugs before and after adjusting was 3.6 (range, 3-6) to 1.9 (4 monotherapy, 22 duotheray, and 2 triple drugs). The most common combined therapies were sodium valproate/lamotrigine (n = 10) and carbamazepine/ topiramate (n = 5). Although the results could be possibly attributed to the spontaneous remission of the seizures, it was still shown that those patients were overtreated. Serial addition to 3 or more antiepileptic drugs is less likely to lead to seizure freedom for patients with difficult-to-treat epilepsy. On the contrary, polytherapy and some antiepileptic drugs could aggravate seizures. Certain combinations of antiepileptic drugs (rational polytherapy) offer better efficacy to control seizures.

http://jcn.sagepub.com/content/early...etype=HWCIT&ct

Does One More Medication Help? Effect of Adding Another Anticonvulsant in Childhood Epilepsy

Abstract
Objectives: To study adding an anticonvulsant in children with uncontrolled epilepsy on ≥1 appropriate anticonvulsants.
Methods: Chart review, patients with intractable epilepsy in a neurology clinic July 1, 2004 to December 31, 2007.
Inclusion: Children on ≥1 stable anticonvulsant who had a second, third, or fourth anticonvulsant added.
Exclusions: Noncompliance, subtherapeutic doses, and/or serum anticonvulsant levels, inappropriate anticonvulsant for seizure type, inadequate documentation, infantile spasms, or significant dosage changes in the baseline anticonvulsant(s) over the follow-up period. Patients were followed until further therapeutic changes occurred or September 30, 2008, whichever came first.
Outcome: ≥50% decrease in seizure frequency.
Results: Charts reviewed: 1886. Patients who met criteria: 84.
Time to assessment: 4 weeks to 42 months (median = 7 months). ≥50% reduction in seizure frequency: 35 of 52 patients with second agent added; 5 of 30 patients with third agent added (P = .0001).
Conclusions: Worthwhile seizure reduction is reasonably likely with the addition of a second anticonvulsant, but much less likely with the addition of third anticonvulsant.

http://www.ncbi.nlm.nih.gov/sites/entrez


First, do no harm: the risks of overtreating children with epilepsy.

BACKGROUND: Although overtreatment with antiepileptic drugs contributes to the morbidity associated with epilepsy, many children still are overtreated.
OBJECTIVE: To evaluate if the withdrawal of at least one antiepileptic drug (AED) in children with refractory epilepsy using polytherapy enable a better seizure control.
METHOD: This was a prospective study. Children with refractory epilepsy using at least two AEDs were included. Once the patient, or guardian, agreed to participate in the study, one or more AED were slowly tapered off. The remaining AEDs dosages could be adjusted as needed, but a new AED could not be introduced.
RESULTS: Fifteen patients were evaluated, three girls; ages ranging from 3 to 18 (mean=8.7 years). After at least one AED withdrawal, two (13.5%) patients became seizure free, seizures improved >50% in 5 (33.5%) patients, did not change in 5 (33.5%), and seizure frequency became worse in 3 (20%). Adverse events improved in 12 patients (80%).
CONCLUSION: The withdrawal of at least one AED is a valuable option in the treatment of selected children with refractory epilepsy.