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My husband started having seizures last year. He was on no

medication at the time and...
My husband started having seizures last year. He was on no medication at the time and not overweight. He has been on 100 mg of lamotrigigine . since then within the last month he has had several seizures. Most often he has panic attacks just before an onset of a seizure. Today he has had 3 seizures one grandmall. He has had 2 MRS cat scan blood test with no known cause its frustrating can you tell me your advice. Thank you. Cheryl
JA: How long have you been dealing with this? Is there anything in particular that seems to make the symptoms better or worse?
Customer: He was better until this last month panic attacks does set some of the seizures
JA: Anything else in your medical history you think the doctor should know?
Customer: Not that I am aware of
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Customer reply replied 21 days ago
Diabetes was ruled out
Answered in 2 hours by:
11/21/2017
Dr Subbanna MD
Dr Subbanna MD, Neurologist (MD)
Category: Neurology
Satisfied Customers: 5,687
Experience: American Board Certified Neurologist, Internal Medicine
Verified

Hi Cheryl, I am an American Board Certified Neurologist with vast experience in diagnosing & treating all neurological as well as all other health/medical conditions, and I am very glad to help you with your health concerns related to your husband.

I am sorry to hear about your husband’s health in the form of seizures and panic attacks. As a neurologist I frequently diagnose & treat this type of health situation and I can certainly help you in this regard.

First I need to ask few questions so that I can gather more information related to your health concerns about your husband and I will follow up with you and post my questions here ASAP. I am typing the questions now and I will follow up with you as soon as I am ready with my questions.

Best Regards!

Dr Subbanna MD

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Kindly answer to these questions, this will help me in gathering additional information related to your health concerns;

1) How old is your husband?

2) Did he have an EEG study (study of the brain waves)? If he had – what was the report? And did he have routine EEG, or any special EEG too?

3) What types of treatments have been tried to control seizures other than lamotrigine? What was the highest dose of lamotrigine tried?

4) Is he being treated for panic attacks? If yes, what are the treatments he is currently on and what treatments had been tried before the current treatments?

5) Are there any already diagnosed medical health conditions such as high blood pressure, thyroid etc?

Kindly reply

Best Regards!

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Customer reply replied 21 days ago
He is 56....he has tried another medication can't recall name had loss of appetite tiredness. 100 mg is highest dose so far. Had EEG last year were told no evidence for causes of seizures has been anti depression but not for 3 years no mention of mess for panic attacks. He has now had 5 seizures today

Okay I see. I appreciate for all these additional information. I am preparing & typing my answer now and I will post my answer here as soon as it is ready. Typing may take few minutes and I will follow up with you and post my answer here the moment I finish with the typing.

Best Regards!

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Customer reply replied 21 days ago
He has been tested for thyroid blood pressure good

Okay I see. I once again appreciate for all these additional information. I am typing now and I will follow up with you and post my answer here the moment I finish with the typing.

Best Regards!

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I am almost done with my typing; I will follow up with you very soon.

Best Regards!

Ask Your Own Neurology Question

Okay I am ready; I am posting my answer here;

I see he has had EEG last year but it was not of any help.

Please see an EEG can provide invaluable information related to his seizure disorder and also tell us what subtype of seizures he is having, and what is the best medication or treatment for the type of seizures he is having etc.

Since his initial EEG (which I assume a routine EEG) has not helped so he requires special EEGs such as a Video EEG or an Ambulatory EEG and this can help us further for the proper evaluation of his seizure disorder.

There is another test called as a Prolactin test, and this test too can provide us invaluable information related to his seizures and help us further in choosing the best course of treatments for the type of seizures he is having.

And regarding lamogtrigine use, please see this is an excellent seizure medication, however we need to use the optimum dose of this medication, if we use sub therapeutic doses then it may not help much, on lamotrigine adult patients should be at least on about 200 mg per day. So the dose of lamotrigine can be slowly optimized and try to reach the maintenance dose of around 200 mg per day, and this itself can help in controlling his seizures. If needed one can go up to around 600 to 800 mg per day too on lamotrigine, although typically most of the seizures come under control when the daily dose is about 200 mg per day.

And you have mentioned his brain scans, blood tests etc all have come normal, but please see it is not unusual for patients with seizure disorder to have normal brain scans & blood tests etc. If there are any structural problems in the brain such as brain tumors or strokes, or any brain scars etc the brain scan such as MRI scan will show it, but many times seizures patients do not have any structural problems causing their brain, and seizures can be caused by chemical imbalance in the brain too, and this occurs at the molecular level of the brain cells and this type of seizure cause cannot be identified on brain scans. And the treatment for this type of seizures is using the seizure meds, at their optimum doses, and controlling trigger factors such as panic attacks, or any other seizure triggers (if present). So the dose of lamotrigine has to be optimized further as mentioned earlier above, in addition to the management plan discussed below here.

I see your husband is having panic disorder, and as pointed above panic disorder too can trigger the onset of seizures. So it is very important to see the panic attacks are brought under control.

The following is a list of treatments that are commonly used to control panic attacks;

CBT (Cognitive Behavioral therapy)

ACT (Acceptance & Commitment Therapy)

Mindfulness meditation

Other types of meditations

Biofeedback

Hypnotherapy

Acupuncture

Yogas

Deep breathing/Deep relaxation techniques

One or more of the over the counter Herbal or Supplement preparations like – L Theanine, Rhodiola rosea, GABA (Gamma Aminobutyric acid), Valerian root extract etc

One of the over the counter combination preparations that contain a combination of certain herbal supplements + vitamins + minerals like magnesium etc - and examples for such combination pills include - Himazol Fast Acting “Extra Strong” Anxiety & Stress Relief Herbal Supplement, Stress Relief & Natural Anti Anxiety supplement etc

One of the benzodiazepine agents like Alprazolam or Clonazepam (not recommended for long term use, also preferably used in small doses)

One of the GABA structural analogues like Gabapentin or Pregabalin

One of the SSRI agents like Fluoxetine or Sertraline

Azapirone agent such as Buspirone

One of the beta blockers like Propranolol or Atenolol

Trazodone

Doxepin

Using a medical devices such as CES (Cranial Electrotherapy Stimulation) etc

The above list contains names of allopathic medications, non-allopathic herbal medications, as well as non-medication treatment options so that the treatment plan may be chosen depending upon the individual preferences. I am not telling all these above treatments are required in his case, but providing you with a list of varieties of treatment options that are available for his condition. If you guys see any of the above treatments he has already tried please disregard them and to consider exploring the ones that he not already tried yet.

In addition to the above special treatments general measures like adequate daily exercises, especially aerobic exercises and healthy & balanced diet is recommended too since they also contribute to bringing panic attacks, as well as seizures too under control.

As discussed above panic disorder is one of the various seizure triggers, there are many more seizure triggers. What I will do now is provide you with a list of seizure triggers and your husband need to try to avoid these below mentioned triggers as much as possible and this will considerably reduce the chances of him having a seizure in the future;

The following is a list of various seizure triggers;

Missing seizure medications/stopping seizure meds abruptly, or taking smaller dose of seizure meds than what is actually recommended

Sleep deprivation (lack of adequate sleep)

Food deprivation (Missing food - hypoglycemia, or low blood glucose)

Dehydration

Infections (fever, if fever occurs fever reducing meds need to be taken asap)

Electrolyte disturbances

Stress

Smoking cigarettes, marijuana

Certain types of computer or video light/flashes

Intake of alcohol, or other toxins and medications etc that can cause lowering of seizure threshold etc

If you guys identify he is having any of the above mentioned seizure triggers he need to try to avoid them as much as possible and this too can help in bringing his seizures under control.

Please see, his seizures can be brought under full control, you guys please try to arrange for the above mentioned investigations, and also he needs to start optimizing the dose of lamotrigine asap, and also to try various measures mentioned above to help with his panic attacks including treatments for panic disorder, as well as avoiding if there are any above mentioned seizure triggers etc, and all these measures can help him in bringing his seizures under full control, so please do not lose hopes.

I earnestly hope you find the above information & list of treatments helpful.

Wishing your husband a quick & complete recovery!

Wishing you guys all the very best!

Please let me know if you have any additional questions or if you want to discuss this further. And please take a moment and kindly click a positive rating (preferably 5 Star/Excellent) to credit for the time & effort put by me in answering your health question, and this is the only way I will be credited for my service to you. If you have follow-up or additional questions you can ask them after the rating too!

Assuring you the best services!

Best Regards!

Dr Subbanna MD

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Customer reply replied 21 days ago
Thank you for the very informative information I will take it all into consideration start making some changes I really appreciate your help and yes definitely worth the 5 Star thank you again Cheryl
Customer reply replied 21 days ago
I do have one more quick question is there any point that ambulance would be needed for transportation to a hospital is that necessary or should we just ride out the seizures until we get him under control

You are very welcome Cheryl! I am very glad to hear you found the above information helpful!

I appreciate the compliments too!

I am typing my reply to your previous question. I will follow up with you very soon.

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If the last seizure had occurred a while ago and since his last seizure he is doing fine, he is awake and alert then visiting the hospital is not absolutely necessary, but if he is still not stable after his last seizure, or if you guys are afraid he may have more seizures then it is better to call the ambulance and to visit to the nearest hospital.

Dr Subbanna MD
Dr Subbanna MD, Neurologist (MD)
Category: Neurology
Satisfied Customers: 5,687
Experience: American Board Certified Neurologist, Internal Medicine
Verified
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Satisfied Customers: 5,687
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