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What Causes Vision Issues And Incoordination Inspite Of Being On Lamotrigine?
Question: Hi, I wanted to know if my current treatment plan with my nurse pract. /psych. was going along the right plan of care. About 1 year ago, I was diagnosed with being bipolar. The first medicine I was placed on was lithium. With a very small dose (unsure of actual dose, but was told the dose was very low). I was so sedated. When I wasn't sleeping, I could not perform regular task. I could not react with my family. At one time I had to complete my nursing ceu's for license renewal and I would sit at the computer and stare at it. I would read questions over and over, get multiple questions wrong and just could not complete. My daughter helped with most, ( you didn't hear from me). By the time my appointment came to see my provider, she was able to see the effect of the med. She immediately drew a lithium level and started me on Geodon. I am not sure what side effect I had. I think it was excessive weight gain. The next med was Depokote. I started off fine. Two or three weeks later when I had an evaluation, showed her how my hands were shaking but she kept me on the med and said it probably was not caused by the Dep. Next my hands would jerk. I couldn't write, when I was on the computer it was difficult. I kept pressing the wrong keys. At one point, I would be holding a cup or glass and I would loose control of it. I could not hold on to what was in my hands. It would be sporadic and unpredictable. I stop the meds on my own. The next day when the office opened, I called her to tell her that I had stopped the med. I was thinking on the lines of tardiness dyskinesia. I knew that some problems could be irreversible. She said that it was not T.D. I told her that I did not want to take that med any longer. She started me on lamictal, which I am on now. Since taking it I have had some problems. I started being unsteady on my feet. When I walked down the halls in my home, I'd have to hold on to the walls. My vision got worse, my speech was slurred, headaches, dizziness and restless. Please do not think I'm the type of person that would complain about EVERY symptom I had or develop is my imagination. I have not stopped the med, but want to. I need to tell you that around the time I was diagnosed with bipolar, an event that caused me to get extremely mad, I had a seizure. I remember talking to a police. The next thing I know I woke up in an ambulance. It took a little while to really understand what happened. The paramedic told me "you've been out for nearly 45 minutes". I really don't think they did a CAT scan while in the ER. They received my medical history from my husband. They started me on
Levetiracetam 50th twice a day. When I say my regular doctor, the routine tests were done. Lab work and MRI and a brain Scan. I had to wait a while for a MR I because I have a spinal neurostimulator. in place to help with pain from an earlier back injury. The MRI just showed a slight enlargement to the pituitary gland. Eventually I was diagnosed with Conversion Disorder. I have sick had a few pseudo-seizures. In summary, I still have hands that shake and the jerking motion to my hands are less but I still occasionally drop items sporadically. With the headaches, dizziness, unsteadiness, problems with my hands and speech I can't help but wonder if it's something brain related.
What's your opinion. (Sorry so long).
Levetiracetam 50th twice a day. When I say my regular doctor, the routine tests were done. Lab work and MRI and a brain Scan. I had to wait a while for a MR I because I have a spinal neurostimulator. in place to help with pain from an earlier back injury. The MRI just showed a slight enlargement to the pituitary gland. Eventually I was diagnosed with Conversion Disorder. I have sick had a few pseudo-seizures. In summary, I still have hands that shake and the jerking motion to my hands are less but I still occasionally drop items sporadically. With the headaches, dizziness, unsteadiness, problems with my hands and speech I can't help but wonder if it's something brain related.
What's your opinion. (Sorry so long).
Brief Answer:
Structural brain issues unlikely.
Detailed Answer:
I read your question carefully and I understand your concern.
Some of those issues you describe are at times caused by drugs such as lamotrigine (incoordination, vision issues) however not to the extent that you describe them. Also regarding your previous movement disorder when under Depakote your physician is right that drug does not cause that type of problem, not TD. So considering the multiple issues inexplicably present with different drugs your physician has a point in thinking it's at least partially related to a conversion disorder.
Regarding the possibility of it being caused by a structural brain abnormality that is unlikely considering the MRI report, the extent of those signs would have to show some visible brain lesions on MRI. Also even if one thought of some movement disorder with no lesions on MRI, it doesn't correlate with the fact that it changed appearance and severity according to the drugs, the symptoms would appear in an insidious manner and have a steady progression in time.
Of course there is the slight pituitary enlargement, for that hormonal level measurements must be done if that hasn't been done already, and if there is found any hormonal dysfunction should be addressed accordingly.
I remain at your disposal for further questions.
Structural brain issues unlikely.
Detailed Answer:
I read your question carefully and I understand your concern.
Some of those issues you describe are at times caused by drugs such as lamotrigine (incoordination, vision issues) however not to the extent that you describe them. Also regarding your previous movement disorder when under Depakote your physician is right that drug does not cause that type of problem, not TD. So considering the multiple issues inexplicably present with different drugs your physician has a point in thinking it's at least partially related to a conversion disorder.
Regarding the possibility of it being caused by a structural brain abnormality that is unlikely considering the MRI report, the extent of those signs would have to show some visible brain lesions on MRI. Also even if one thought of some movement disorder with no lesions on MRI, it doesn't correlate with the fact that it changed appearance and severity according to the drugs, the symptoms would appear in an insidious manner and have a steady progression in time.
Of course there is the slight pituitary enlargement, for that hormonal level measurements must be done if that hasn't been done already, and if there is found any hormonal dysfunction should be addressed accordingly.
I remain at your disposal for further questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
You are right about the problem not being T.D. she said the symptoms were likely EPS. and put me on cogentin for a few days. How long will it take for the issue with my hands to go away? What do you think is causing it? In your opinion, what is the best med for me to prescribed for the bipolar problems? By the way, the last day or two ago, I really had aggressive behavior. Really mean and arguing with my husband alot. Weeks go by and I am fine but then the meanness returns. Really snappy at people, confrontational. Up all night. I know I have bipolar but shouldn't it be one way or the other?
Brief Answer:
Read below.
Detailed Answer:
Extrapyramidal symptoms are not typically caused by those drugs. When they are drug related they are usually related to antipsychotics not antiepileptics, that is why I believe there could be a conversion (psychogenic) element present at its root as was suggested to you. However while you didn't mention mention it in your query I notice that you take Compazine as well, which is an anti-psychotic which can commonly cause eps, so if eps is believed to be the case that is the drug which might be considered to be changed to an atypical antipsychotic with fewer eps side effects.
If they were related to the drugs the issues with the jerking of the hands should subside over the course of a a few weeks.
I see also that you take Gabapentin as well, that could also contribute to issues of dizziness and incoordination even more so when added to other drugs such as Lamictal.
As for the best treatment of bipolar problems, the mainstay are mood stabilizers, and you already seem to be getting the most used ones, have tried Lithium and Depakote, now on Lamotrigine which is one of the mood stabilizers with fewer side effects. Other additional therapies depend on the symptoms, I already mentioned antipsychotics which as I mentioned might be switched to the newer atypical ones with fewer side effects.
I am not sure what you mean by your last sentence, those manifestations do seem to be a part of a maniacal phase typical for bipolar disorder.
I hope to have been of help.
Read below.
Detailed Answer:
Extrapyramidal symptoms are not typically caused by those drugs. When they are drug related they are usually related to antipsychotics not antiepileptics, that is why I believe there could be a conversion (psychogenic) element present at its root as was suggested to you. However while you didn't mention mention it in your query I notice that you take Compazine as well, which is an anti-psychotic which can commonly cause eps, so if eps is believed to be the case that is the drug which might be considered to be changed to an atypical antipsychotic with fewer eps side effects.
If they were related to the drugs the issues with the jerking of the hands should subside over the course of a a few weeks.
I see also that you take Gabapentin as well, that could also contribute to issues of dizziness and incoordination even more so when added to other drugs such as Lamictal.
As for the best treatment of bipolar problems, the mainstay are mood stabilizers, and you already seem to be getting the most used ones, have tried Lithium and Depakote, now on Lamotrigine which is one of the mood stabilizers with fewer side effects. Other additional therapies depend on the symptoms, I already mentioned antipsychotics which as I mentioned might be switched to the newer atypical ones with fewer side effects.
I am not sure what you mean by your last sentence, those manifestations do seem to be a part of a maniacal phase typical for bipolar disorder.
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I'm not on compazine. I texted that I was allergic to it. I'm not on multiple mood stablizers.
Brief Answer:
Read below.
Detailed Answer:
My apologies about Compazine, you are right it's in the allergies field, I read it in continuation to the list of current medications mistakenly. I guess subconsciously trying to find an explanation for EPS, because as I said before the other drugs you mention do not typically cause it.
I didn't say you are on multiple mood stabilizers, you were clear on that, but that you have tried the main ones, Lithium and Depakote, which you later interrupted. As I said with those two out of the picture Lamotrigine is a good option. An alternative to that is Carbamazepine, but it has its potential of side effects as well.
Apart from that an additional treatment, considering also your aggressive behavior episodes, are anti-psychotics. The recommended ones are those belonging to atypical or 2nd generation class of antipsychotics which have fewer EPS side effects. Geodon is such a drug, I am not sure whether you still take it though since you mention it in your query but not listed in current medication field.
Feel free to ask further questions.
Read below.
Detailed Answer:
My apologies about Compazine, you are right it's in the allergies field, I read it in continuation to the list of current medications mistakenly. I guess subconsciously trying to find an explanation for EPS, because as I said before the other drugs you mention do not typically cause it.
I didn't say you are on multiple mood stabilizers, you were clear on that, but that you have tried the main ones, Lithium and Depakote, which you later interrupted. As I said with those two out of the picture Lamotrigine is a good option. An alternative to that is Carbamazepine, but it has its potential of side effects as well.
Apart from that an additional treatment, considering also your aggressive behavior episodes, are anti-psychotics. The recommended ones are those belonging to atypical or 2nd generation class of antipsychotics which have fewer EPS side effects. Geodon is such a drug, I am not sure whether you still take it though since you mention it in your query but not listed in current medication field.
Feel free to ask further questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you so much! I trust my Healthcare provider but wanted a second professional opinion. This site is great! I'm defiantly continuing my monthly membership and tell others about it as well.
Thanks Dr. Taka
Thanks Dr. Taka
Brief Answer:
Thank you
Detailed Answer:
Thank you for your appreciative words. I hope you'll feel better soon and won't need this service, but in any case me or my colleagues will be at your service.
Thank you
Detailed Answer:
Thank you for your appreciative words. I hope you'll feel better soon and won't need this service, but in any case me or my colleagues will be at your service.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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