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Dr. Frank
Dr. Frank, Board Certified Physician
Category: Neurology
Satisfied Customers: 9000
Experience:  Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
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I started having headaches about a year ago, (60 y/0 male)

Customer Question

I started having headaches about a year ago, (60 y/0 male) along with dificulty in balancing and dizziness. Along with all this, I have been experiencing back pain and trouble sleeping, coupled with cognitive dificulties and extreme tiredness.
All MRI's EEG's, EKG's, bloodwork etc shows up normal. For the past several months I have been having seizures, anytime of day, no real rhyme nor reason, just fall down or just stay asleep for 15 minutes or several hours with no recollection of where I've been. Several of these have been witnessed, and described as clenched tight from head to toe and shaking. When I wake up I'm exhausted and feel like I've been beat up. I can't work, and am becoming increasingly depressed. Help
Submitted: 1 year ago.
Category: Neurology
Expert:  Dr. Frank replied 1 year ago.

HI. How long have you been on the Fentanyl patches? You can get seizures from variable dosing which is a common problem with those patches if you have been using this chronically. That combined with the oxycontin and the Ativan is a lethal combination. I would bet it is contributory to this problem. Please get back to me to discuss this further. What else have you considered for pain control? Have you attained tolerance where you doses have to be increased? Get back to me to discuss Dr Frank

Customer: replied 1 year ago.
I've gone from 37 to 25 per 3 days on the fentanyl and from 90 mg to 10 mg per day soon the oxycontin. I take 2 to 3 mg of ativan daily. In addition I use accupuncture, fresh tumeric, ibuprofen, Brazil nuts and. Fresh pineapple.
Expert:  Dr. Frank replied 1 year ago.

Not to sound too simplistic, but your entire paragraph: headaches, cognitive impairment, trouble sleeping, balance problems, dizziness, could all be attributed to the cocktail of fentanyl, IR oxycodone and lorazepam taken in combination. I guess that is reinforced by the fact that your MRI, the EEG's and the rest are all normal, that is what you would expect in the setting of opiate induced narcosis accentuated by benzodiazepines that you are tapering.

You are doing great to taper, but that taper may have caused the seizures that you described. One suggestion might be to consider a buprenorphine patch (Butrans) as maintenance while you continued to taper off the fentanyl patches and the oxycodone. A Pain management doc would help you with that transition. Also not to be too critical, but you are on a high dose of Topiramate, is that for migraine? What happens when you are on 50 to 100 mg? No one has shown in studies that a higher dose of topiramate is any better for migraine control than the normal dose, of up to 100 mg. If you are 60, and you have only had headaches for a year(?), I am unsure why your doctor feels you have migraine, as they do not usually start at that age. Did you have a history of headaches in adolescence? Or a family history of migraine? Get back to me to discuss if I can help. Dr frank