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Subject: Re: Dilantin VS Lamictal
Forum: The Neurology and Neurosurgery Forum
Topic Area:
Posted by CCF Neurology MD on July 11, 1997 at 11:33:38:
In Reply to: Dilantin VS Lamictal posted by Warren on June 28, 1997 at 20:39:25:
: Hello: I am diagnosed as having seizures (complex partial that secondarily generalize). An EEG I had done related the following: "The EEG is mildly
abnormal, demonstrating scattered sharp activity in the frontal regions and brief bursts of spike, sharp and slow sharp activity". I have been
taking Dilantin 400 mg bid daily for about 18 years. I have annoying cognitive side effects, and also suffer depression/anxiety. My seizures,
however, are controlled except for an occasional aura now and then,related to flickering lights, ie: sun through trees. I am interested
in the possibility of changing to Lamictal (as monotherapy). Does it have fewer side effects than Dilantin? Is Lamictal used alone for my kind of
seizure disorder? Is the Dilantin causing my depression/anxiety, or is that caused by the seizure disorder? I've heard that an EEG showing
problems in the frontal region of the brain (like mine), can be tied to various mood disorders. Finally, I have an extremely unpleasant knot
in my stomach (tension) all of the time. I can't decide if it's the anxiety problem (too much adrenalin/cortisal in my system?) or something
to do with the seizure disorder. Any comments and/or suggestions would be very appreciated.
=Warren, Lamictal has been approved for your type of seizures(complex partial seizures with secondary generalization) as a monotherapy since 12/94. Its major side effects known at this time are skin rash followed by diplopia, drowsiness, ataxia and headaches). However, long-term (using it greater than ten years) side effects are unknown.
On the other hand, many of the side effects associated with dilantin are well known both for short and long term use. In addition many of the side effects are dependent on blood level and are seen when they exceed therapeutic levels (e.g.nystagmus, ataxia and lethargy). Long term use can result in mild gingivial hypertrophy
or a peripheral neuropathy in certain patients. Therefore, I don't feel it is possible to compare the two agents at this time if you are concerned about short and long term side effects. While dilantin can cause transient nervouseness, I feel that your depression/anxiety may be in part related to you dealing with your seizure disorder and
how it may have affected your lifestyle. I am unaware if EEG patterns can be related to mood disorders in children or adults. While complex partial seizures can have gustatory auras, to have them continously for days or weeks would suggest a non-epileptic source. If you are serious on changing from dilantin to lamictal, I would recommend you
be evaluated by one of our Epilepsy specialist (216-444-5559) who could not only advise you on appropriate therapy but could also discuss with you more fully the other issues that you have raised.
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