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Is Lamotrigine The Right Medication For Seizures?

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Posted on Wed, 11 Jun 2014
Question: Good evening Doctor.I had a servere brain hemorage last September.In feb & march I had a total of 3 seizures. My doctor has surgested I take Lamotrigine. Iam not sure. What do you think?

doctor
Answered by Dr. Vinay Bhardwaj (20 minutes later)
Brief Answer:
An Anti-Seizure medication is the safest option

Detailed Answer:
Hi, Thanks for coming to HealthCareMagic. I am so sorry to hear about your Sub Arachnoid from last September. I trust you are on the mend and that your are getting the Physical and Occupational therapy that will help you recover from the nerve damage that might have caused.

Now. depending on the force of the trauma and where you got hit, there are a few different resulting types of SAHs(Sub Arachnoid Hemmorhages). I won't traumatize you further with a full accounting of the different types, but I want to boil it down to this... the part of th brain the bled means alot in the long term management of seizure complications. An SAH into the 'Ventricle' (the liquid filled center of the brain) is pretty risky business and I would recommend that you be on antiseizure meds (like Lamictal, Lamotrigine, though there are others) for more than a year. On the other hand, a small bleed into the parietal cortex wouldn't warrant that much caution.

So all in all, if you could tell e a bit more about the position and extent of the bleed that happened in Sept, I can go into a good amount of detail with you on the anti seizure precautions that need to be taken.

From a more general point of view though.. yes, people who suffer from traumatic Hemorrhages do benefit from anti-siezure prophylaxis, but not forever. if there are no seizures for a certain period after the insult.. then we taper and stop them, but since you have had a few seizures, it's probably a smart idea to carry them on for awhile longer.

I hope I didn't make things worse. I look forward to your reply and remember, the more information you can give me, the more useful I will be to you. Take Care

Vinay
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vinay Bhardwaj (48 hours later)
Sorry to be so long in replying to you.Thankyou for your answer to my question.I have some more information for you.This information comes from my hospital discharge summary. CT head shows blood in the perimesencephalic and right sylvian fissue regions,most likely traumatic subarachnoid haemorrhage,but possibly spontaneous in origin; there was also a right temporopolar contusion and left occipital fracture. No spinal fracture. CT angiongram did not show any aneurysm but was of poor quality. I had a new CT in December and it said :- Marked gliosis in the anteroinferolateral aspects of both the right frontal lobe and right temporal lobe at the side of previous haemorrhage confusion is accompanied by mild ballooning of the temporal horn lateral ventricle.The white matter low-attenuation extending into the right parietal lobe on the previous examination has resolved.Impression;- Marked right frontal and temporal lobe gliosis.
Thankyou very much for your help and look forward to your reply. Yours XXXXXXX
doctor
Answered by Dr. Vinay Bhardwaj (28 hours later)
Brief Answer:
Yup, sylvian fissure bleeds need long term meds

Detailed Answer:
Hey there, thanks for following up. Based on the scan impression here.. I'm thinking that these are real seizures and you need to be covered on antiepileptics for awhile.

The Sylvian fissure is a deep furrow in the brain. When you bleed into it the total area of cortex that is exposed to blood is pretty huge. That really increases the risk of seizure.

The gliosis is to be expected... instead of gliosis ... you can use the word scarring... The brain was injured.. neurons died.. and now there is some scarring.. I wouldn't worry to much about that.

As to the aneurysm issue. I wish the scan had been better. but i wouldn't bother rescanning... there is a risk to that as well from the contrast that they have to give you.

Make sense? let me know what you are thinking. Look forward to answer you.

Take care
Dr Vin


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vinay Bhardwaj (9 hours later)
Thank you for your reply doctor. I would like to know if I go on this medication would I be allowed to drink alcohol. Beer & wine is what I drink. I don't drink during the week just at weekends but have cut down a lot since my seizures. Yours XXXXXXX
doctor
Answered by Dr. Vinay Bhardwaj (13 hours later)
Brief Answer:
Risky!!! Meds or not

Detailed Answer:
Look, seizures are a problem where there is basically an electrical short circuit in the brain. The short circuiting is due to a problem with 2 major elements in the neurons... Sodium Channels and Calcium Channels. I don't want to bore you to death with theory.. But the basic thing is that alcohol makes it more likely that those channels would get leaky and cause the short circuit.. Kids who binge drink in a single night can give themselves a seizure without any underlying disorder.

In your case. Every time you drink ANYTHING with alcohol in it... you are increasing your chances of having a seizure.. It's that simple. You have to weight that risk against the need for that drink. I wish I could give you numbers... but there's never been a quantitative study showing the risks.. we just know that it can happen.

Make any sense?

Vin
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vinay Bhardwaj (3 days later)
I would like to thank you Doctor for all your help and advise that you have given me it has been very useful to me. Yours XXXXXXX
doctor
Answered by Dr. Vinay Bhardwaj (12 hours later)
Brief Answer:
I can only hope it helps!

Detailed Answer:
Hey there. I hope the advice becomes useful for you. If you get a chance. Drop me a line to let me know how things are going.

Vin
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vinay Bhardwaj (36 hours later)
Many thanks again Doctor and I will keep you informed how things progress. Do I contact you on this site or do you have an email address I can use? Yours XXXXXXX
doctor
Answered by Dr. Vinay Bhardwaj (3 hours later)
Brief Answer:
the site is my only way

Detailed Answer:
i know its annoying. but the site is my only way of keeping in touch with patients. Company policy and all
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Vinay Bhardwaj (17 minutes later)
Not a problem Doctor will keep in touch. Hope you have a good weekend yours XXXXXXX
doctor
Answered by Dr. Vinay Bhardwaj (3 minutes later)
Brief Answer:
Take Care

Detailed Answer:
All the best.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Vinay Bhardwaj

Neurologist, Surgical

Practicing since :2006

Answered : 544 Questions

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Is Lamotrigine The Right Medication For Seizures?

Brief Answer: An Anti-Seizure medication is the safest option Detailed Answer: Hi, Thanks for coming to HealthCareMagic. I am so sorry to hear about your Sub Arachnoid from last September. I trust you are on the mend and that your are getting the Physical and Occupational therapy that will help you recover from the nerve damage that might have caused. Now. depending on the force of the trauma and where you got hit, there are a few different resulting types of SAHs(Sub Arachnoid Hemmorhages). I won't traumatize you further with a full accounting of the different types, but I want to boil it down to this... the part of th brain the bled means alot in the long term management of seizure complications. An SAH into the 'Ventricle' (the liquid filled center of the brain) is pretty risky business and I would recommend that you be on antiseizure meds (like Lamictal, Lamotrigine, though there are others) for more than a year. On the other hand, a small bleed into the parietal cortex wouldn't warrant that much caution. So all in all, if you could tell e a bit more about the position and extent of the bleed that happened in Sept, I can go into a good amount of detail with you on the anti seizure precautions that need to be taken. From a more general point of view though.. yes, people who suffer from traumatic Hemorrhages do benefit from anti-siezure prophylaxis, but not forever. if there are no seizures for a certain period after the insult.. then we taper and stop them, but since you have had a few seizures, it's probably a smart idea to carry them on for awhile longer. I hope I didn't make things worse. I look forward to your reply and remember, the more information you can give me, the more useful I will be to you. Take Care Vinay