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What Causes Recurrence Of Seizure After Taking Keppra And Lamotrigine?
Question: My husband is 31 and has seizures since he was 11. It started with absence seizure and at the age of 17 he started having convulsions. He has been on carbamazepine 1600 mg per day for 8 years aND had seuzures at an average of twice per year. Last year after marriage the frequency increased. Thrice in 3 months. We went to a different doc. He said that he had primary generalized seizure or a right right frontal focus with hemispheric bisynchrony. He also said that carbamazepine is not right medication for it slowly changed it to kepra. My husband dint have seizures for 5 months. After carbamazepine was completely stopped and he was completely on kepra , he got seizure. He takes 3700 MG of kepra per day. Now doc has put him on lamotrigine to target to 200mg per day.. during the past 2 months he has had seizure 5 times ! Doc is asking us to wait till the tablet takes effect. but he is having more seizures than wat he had anytime. uncertain of what to do. Please advise
Brief Answer:
A second drug might eventually be ncessary.
Detailed Answer:
I read your question carefully and I understand your concern.
At times it is difficult to find the most appropriate drug to best prevent seizures and different ones can be tried. There are cases who are well controlled with one drug, others who need multiple drugs and unfortunately some cases don't respond well to treatment at all.
To be sure the about the efficacy of a drug at times it is necessary to wait for the appointed dosage rather than jump from one medication to the other too soon. So for the moment I would wait as your doctor suggests. If Lamotrigine doesn't seem to be effective since he has already been under three different single-drug regimens with not sufficient success, I would add a second drug such as valproic acid. Its combination with lamotrigin is a very widely used one as it permits as they increase each others levels and the same effect can be reached with lower dosages.
I remain at your disposal for further questions.
A second drug might eventually be ncessary.
Detailed Answer:
I read your question carefully and I understand your concern.
At times it is difficult to find the most appropriate drug to best prevent seizures and different ones can be tried. There are cases who are well controlled with one drug, others who need multiple drugs and unfortunately some cases don't respond well to treatment at all.
To be sure the about the efficacy of a drug at times it is necessary to wait for the appointed dosage rather than jump from one medication to the other too soon. So for the moment I would wait as your doctor suggests. If Lamotrigine doesn't seem to be effective since he has already been under three different single-drug regimens with not sufficient success, I would add a second drug such as valproic acid. Its combination with lamotrigin is a very widely used one as it permits as they increase each others levels and the same effect can be reached with lower dosages.
I remain at your disposal for further questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
He is currently on Kepra 3700mg/day and lamotrigene 200 mg/day. Do you think valproic acid is better than Kepra ?
His weight is 84KGS. Doc is planning on increasing lamotrigene to a XXXXXXX of 600mg/day in case he keeps getting seizures. Is that a high dosage along with 3700 mg kepra ?
His weight is 84KGS. Doc is planning on increasing lamotrigene to a XXXXXXX of 600mg/day in case he keeps getting seizures. Is that a high dosage along with 3700 mg kepra ?
Brief Answer:
Read below.
Detailed Answer:
I see, thank you for bringing that information as I had thought the doc had put him on Lamotrigine instead of Keppra, not combined.
3700 mg a day is a pretty high dose, whether combined with another drug or not. Usually dosage of Keppra doesn't exceed 3000 mg a day. So while it's one of the antiepileptics with fewer side effects, I wouldn't be very fond of that dosage.
And if his seizures are increasing in frequency while still on Keppra and increasing Lamotrigine I wouldn't have that high expectations for higher doses really.
Regarding which one is better, valproic acid or levetiracetam (Keppra), there is no such response as one is good and the other not. Both are widely used drugs and effective in a wide range of seizures.
There are some combinations though which are more preferred than others. While they are not written in stone, can vary between physicians and doesn't necessarily mean one is right and the other wrong, some more common combinations for Keppra are topiramate, carbamazepine, oxcarbazepine. More common combinations for lamotrigine are valproic acid, topiramate, gabapentin.
I hope to have been of help.
Read below.
Detailed Answer:
I see, thank you for bringing that information as I had thought the doc had put him on Lamotrigine instead of Keppra, not combined.
3700 mg a day is a pretty high dose, whether combined with another drug or not. Usually dosage of Keppra doesn't exceed 3000 mg a day. So while it's one of the antiepileptics with fewer side effects, I wouldn't be very fond of that dosage.
And if his seizures are increasing in frequency while still on Keppra and increasing Lamotrigine I wouldn't have that high expectations for higher doses really.
Regarding which one is better, valproic acid or levetiracetam (Keppra), there is no such response as one is good and the other not. Both are widely used drugs and effective in a wide range of seizures.
There are some combinations though which are more preferred than others. While they are not written in stone, can vary between physicians and doesn't necessarily mean one is right and the other wrong, some more common combinations for Keppra are topiramate, carbamazepine, oxcarbazepine. More common combinations for lamotrigine are valproic acid, topiramate, gabapentin.
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you. Also doc said that carbamazepine is not a right drug for partial generalized seizures. Is that true ?
What would be your suggestion ? To wait for the increase in Lamotrigine to take effect or to change the doc ? Because i am a little confused here.
He was not having any seizures for 5 months while he was in the increasing dose of kepra and decreasing dose of carbamazepine.
He also gets myoclonic jerks while drifting to sleep. Doc said it should decrease with the new tablet but i do no see any progress.
Also is there anything else that can be done to avoid his attacks. Like his diet , excercise ?
What would be your suggestion ? To wait for the increase in Lamotrigine to take effect or to change the doc ? Because i am a little confused here.
He was not having any seizures for 5 months while he was in the increasing dose of kepra and decreasing dose of carbamazepine.
He also gets myoclonic jerks while drifting to sleep. Doc said it should decrease with the new tablet but i do no see any progress.
Also is there anything else that can be done to avoid his attacks. Like his diet , excercise ?
Brief Answer:
Read below
Detailed Answer:
I am sorry if perhaps my answers are increasing your confusion, I can perfectly understand you, it's a complex subject often with no clear cut answers.
Carbamazepine is a good drug for partial generalized seizures, I don't think that was the cause your doctor interrupted it. My assumption is that he interrupted it because of the history of absence seizures and myoclonic jerks, carbamazepine has the potential to worsen those types of seizures.
Since you are embarked on this Lamotrigine course I would continue a little more to make sure it's ineffective, wouldn't go over 400mg though. If situation remains the same you should have a talk with your doctor regarding the combination of Levetiracetam and Carbamazepine as it seems it has been the most successful one until now. I understand the intention wasn't to combine them but the clinical history of no seizures can't be ignored. Dosage might not need to be so high (1600mg of Carbamazepine is a lot as well as the 3700mg of Keppra, while you were making the switch you were on lower doses of them both)
The other option especially if he's skeptical about Carbamazepine, is the combination of valproic acid and lamotrigine. Frankly one can't go wrong with valproic acid as its indications include all types of seizures.
It's difficult for me to express an opinion on your doctor, continuing or switching to another specialist. I can recommend for your husband to be followed by a neurologist preferably with epilepsy as a sub-specialty, but I can't judge a fellow colleague since I don't know all the details of your husbands' seizures and his tests.
As for lifestyle changes I guess you must know about avoiding alcohol, caffeine and other stimulants, regular sleep schedule. There are no special exercises, just avoid dehydration.
I hope your husband will get better soon.
Read below
Detailed Answer:
I am sorry if perhaps my answers are increasing your confusion, I can perfectly understand you, it's a complex subject often with no clear cut answers.
Carbamazepine is a good drug for partial generalized seizures, I don't think that was the cause your doctor interrupted it. My assumption is that he interrupted it because of the history of absence seizures and myoclonic jerks, carbamazepine has the potential to worsen those types of seizures.
Since you are embarked on this Lamotrigine course I would continue a little more to make sure it's ineffective, wouldn't go over 400mg though. If situation remains the same you should have a talk with your doctor regarding the combination of Levetiracetam and Carbamazepine as it seems it has been the most successful one until now. I understand the intention wasn't to combine them but the clinical history of no seizures can't be ignored. Dosage might not need to be so high (1600mg of Carbamazepine is a lot as well as the 3700mg of Keppra, while you were making the switch you were on lower doses of them both)
The other option especially if he's skeptical about Carbamazepine, is the combination of valproic acid and lamotrigine. Frankly one can't go wrong with valproic acid as its indications include all types of seizures.
It's difficult for me to express an opinion on your doctor, continuing or switching to another specialist. I can recommend for your husband to be followed by a neurologist preferably with epilepsy as a sub-specialty, but I can't judge a fellow colleague since I don't know all the details of your husbands' seizures and his tests.
As for lifestyle changes I guess you must know about avoiding alcohol, caffeine and other stimulants, regular sleep schedule. There are no special exercises, just avoid dehydration.
I hope your husband will get better soon.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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