Brief Answer:
Phentyal can make you drowsey, stoppage of meds

Detailed Answer:
Hello there, Thanks for coming to HealthCareMagic.

First, let me restate your issues so I am sure I have understood the information correctly

In 2002 - You sustained a severe Head injury for which you underwent surgery

From 2002 to 2014 February (6 months ago) - You have been taking Phenytal, at first the 50mg dose combo and then two years later, the 30mg dose combo. During this entire roughly 12 year period I am assuming you have never had a seizure. Please correct me if my assumption is wrong.

2014 Feb - You stopped taking Phenytal altogether.

Recently (within last 6 months???): you have been feeling 'Lazy' while not on the medication.

I hope the timeline i have given here matches your memory of the issue.

Now, lets address the usage of 'Phenytal', which is a combination drug which contains Phenobarbitone and Phenytoin Sodium (both anticonvulsant medications)

I am loath to disagree with your original neurosurgeon without having examined you first, and without knowing if you have been seizure free since your head injury. But in this case, I must point out that most of the recent clinical data shows that IF THE PATIENT IS SEIZURE FREE, then prophylactic (ie Preventive) anticonvulsants like Phenytal can be stopped.

I normally recommend stoppage within 6-12 months. There is a growing body of evidence which shows that they are not really needed beyond 7 days from the head injury.

So in my opinion, 12 years is too long and the drug certainly need not be taken life long (again, let me stress that this is assuming you have been seizure free this whole time.).

If you have had a seizure in the ensuing years, then this story changes quite drastically. If any patient of mine who has a seizure post head injury, I will normally recommend they continue the anti-convulsant for at least another 6 months and then re-evaluate the situation. This is my way of dealing with the situation. Unfortunately there are no established guidelines in this regard.

Overall, I am happy you have stopped the Phanytal, and I would NOT recommend you restart it.

Next, the side effects of these medications are numerous and the ones that I commonly come across include fatigue and, rashes and dizziness. There is a small chance of some liver damage as well, but that's not very common.

Finally, as far as you more recent feeling of 'Laziness'. Let me change the term and say that you are feeling fatigued. Since you stopped the meds 6 months ago, I do not believe that this feeling is due to the medication. We need to dig deeper into the causes of this symptom.

I would appreciate it if you could expand on this feeling of fatigue and tell me in detail how you noticed it and under what circumstances. Then we can delve into the causes.

So to sum up. I'm glad you stopped the phenytal and do not think that it needs to be taken life long. I do not believe that your fatigue is related to the medication and I doubt that you are dependent on it. On the other hand, I DO believe that your fatigue is a real issue and needs to be investigated further.

I look forward to your reply. Feel free to ask me anything else in relation to this.

Vinay

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