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Neurology (Expert Forum)
Dosage levels query on LAMOTROGINE (Lamictal) - (sorry, it's very long)
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Dosage levels query on LAMOTROGINE (Lamictal) - (sorry, it's very long)
by Zappy, May 23, 2001 12:00AM
Background info:
I developed temporal lobe epilepsy (left side) 6 years ago at the age of 25 years. After ruling out brain tumour after several MRI scans, doctors cannot tell me how or why this started. I resisted anti-convulsants for some time but the seizures continued. I tried every anti-convulsants going but really suffered with the side-effects. Eventually I settled on Lamotrigine, i think it was eventually dosed at 200mg or maybe 250mg daily as monotherapy, but I can't remember for sure.
Eventually I weaned off the drugs (after about a year i think) and everything was fine, started driving. Then 2 years ago I suffered a tonic-clonic seizure out of the blue. I definitely resisted the anti-convulsants this time as 1) I had just got married and was trying for a baby, and 2) i still suffered the odd complex partial seizure whilst on the Lamotrogine and decided the balance wasn't worth it - my quality of life was so low and they didn't stop the seizures entirely anyway. So eventually the seizures stopped after a few months (during this time i suffered with complex partials and secondarily generalised tonic-clonics but not constantly and with recovery time in between of weeks at a time). Eventually started driving again etc and got on with it.
Then a couple of months ago i developed the most excrutiating headache which lasted a month and didn't respond to morphine or anti-migraine drugs. Went off for another MRI scan etc but luckily nothing there. It stopped and after 9 days of good health i suffered a complex partial. These then continued until they were averaging 2 per day. I now am almost definite that the headache was caused by night-time seizures that I was unaware of, and a combination of the seizures together with a total lack of quality sleep caused all the pain. During this time I was so reluctant to go back on the drugs. I have been taking various supplements (including B complex and Magnesium). I smoke cannabis recreationally as it suits me and I don't drink much alcohol at all. I was concerned how this might affect the E but after some research found out it has anti-convulsant properties and the fact that I have never suffered a seizure whilst smoking it convinced me that I was doing no harm. The complex partials stopped for nearly 2 weeks (all this time I have been waiting to see a Neurologist by the way) then a tonic-clonic came out of the blue last thursday followed by another 3 on Friday. I realised I had no more choice and would have to go back on the drugs.
So......sorry for all the waffle, here at last is my question. I am still waiting to see a Neurologist (i have been referred now to the Institue of Neurology at Queens Square, London to see a Dr Mark Richardson in another few weeks' time) so I have got my G.P. prescribing the medication. He prescribed me 200mg daily (split to 2 doses of course) straight away which I took for a day and half. I then found the original old packet of Lamotrogine, it was called a starter pack and days 1-14 was 2 x 25mg daily, then days 15-28 was 2 x 50mg daily. I told my G.P. who then prescribed me 2 x 50mg but i still feel dreadful and I think this dose is too high, considering I am starting the drugs all over from new, as it was 5 years or so since I was on them last time.
Please could you tell me what you think my dosage should be. For today I have broken the 50mg tablets in half and have taken 25mg only and will take another 25mg this evening. But I have no-one to ask whether I am doing the right thing or not. My G.P. doesn't really know, he tends to ask me what I think.....
Thank you so much in advance for your help and I am sorry it took so long to get to the meat of the matter.
I am also really concerned about "Geschwind's Syndrome" which I have only just found out about. I am a walking case history of this syndrome and this is what actually convinced me to go back on the medication, as I thought maybe it has got much worse because of the continuing seizures when I wasn't on medication. Do you think this is right, or would it have worsened anyway?
Thank you thank you thank you for your advice.
I developed temporal lobe epilepsy (left side) 6 years ago at the age of 25 years. After ruling out brain tumour after several MRI scans, doctors cannot tell me how or why this started. I resisted anti-convulsants for some time but the seizures continued. I tried every anti-convulsants going but really suffered with the side-effects. Eventually I settled on Lamotrigine, i think it was eventually dosed at 200mg or maybe 250mg daily as monotherapy, but I can't remember for sure.
Eventually I weaned off the drugs (after about a year i think) and everything was fine, started driving. Then 2 years ago I suffered a tonic-clonic seizure out of the blue. I definitely resisted the anti-convulsants this time as 1) I had just got married and was trying for a baby, and 2) i still suffered the odd complex partial seizure whilst on the Lamotrogine and decided the balance wasn't worth it - my quality of life was so low and they didn't stop the seizures entirely anyway. So eventually the seizures stopped after a few months (during this time i suffered with complex partials and secondarily generalised tonic-clonics but not constantly and with recovery time in between of weeks at a time). Eventually started driving again etc and got on with it.
Then a couple of months ago i developed the most excrutiating headache which lasted a month and didn't respond to morphine or anti-migraine drugs. Went off for another MRI scan etc but luckily nothing there. It stopped and after 9 days of good health i suffered a complex partial. These then continued until they were averaging 2 per day. I now am almost definite that the headache was caused by night-time seizures that I was unaware of, and a combination of the seizures together with a total lack of quality sleep caused all the pain. During this time I was so reluctant to go back on the drugs. I have been taking various supplements (including B complex and Magnesium). I smoke cannabis recreationally as it suits me and I don't drink much alcohol at all. I was concerned how this might affect the E but after some research found out it has anti-convulsant properties and the fact that I have never suffered a seizure whilst smoking it convinced me that I was doing no harm. The complex partials stopped for nearly 2 weeks (all this time I have been waiting to see a Neurologist by the way) then a tonic-clonic came out of the blue last thursday followed by another 3 on Friday. I realised I had no more choice and would have to go back on the drugs.
So......sorry for all the waffle, here at last is my question. I am still waiting to see a Neurologist (i have been referred now to the Institue of Neurology at Queens Square, London to see a Dr Mark Richardson in another few weeks' time) so I have got my G.P. prescribing the medication. He prescribed me 200mg daily (split to 2 doses of course) straight away which I took for a day and half. I then found the original old packet of Lamotrogine, it was called a starter pack and days 1-14 was 2 x 25mg daily, then days 15-28 was 2 x 50mg daily. I told my G.P. who then prescribed me 2 x 50mg but i still feel dreadful and I think this dose is too high, considering I am starting the drugs all over from new, as it was 5 years or so since I was on them last time.
Please could you tell me what you think my dosage should be. For today I have broken the 50mg tablets in half and have taken 25mg only and will take another 25mg this evening. But I have no-one to ask whether I am doing the right thing or not. My G.P. doesn't really know, he tends to ask me what I think.....
Thank you so much in advance for your help and I am sorry it took so long to get to the meat of the matter.
I am also really concerned about "Geschwind's Syndrome" which I have only just found out about. I am a walking case history of this syndrome and this is what actually convinced me to go back on the medication, as I thought maybe it has got much worse because of the continuing seizures when I wasn't on medication. Do you think this is right, or would it have worsened anyway?
Thank you thank you thank you for your advice.
Doctor's Answer
by CCF-Neuro-M.D.-RPS, May 23, 2001 12:00AM
Dear Zappy:
Sorry to hear about your temporal lobe epilepsy. TLE or temporal lobe epilepsy is >90% of the time intractable and requires life long medication which is usually only partially effective. The best therapy is usually surgery, if one is a good candidate. I would not think your self safe from seizure activity by just smoking pot. I would disagree with your information as the data is not conclusive, in addition you have seizures and you smoke so evidence does not favor your hypothesis in your case. Sorry, I wish it did stop temporal lobe seizures and then it would become legal. I would start your lamictal as indicated in the package insert. This will decrease side effects. So, what make you think that you have Gerswind syndrome?
Sincerely,
CCF Neuro MD
Sorry to hear about your temporal lobe epilepsy. TLE or temporal lobe epilepsy is >90% of the time intractable and requires life long medication which is usually only partially effective. The best therapy is usually surgery, if one is a good candidate. I would not think your self safe from seizure activity by just smoking pot. I would disagree with your information as the data is not conclusive, in addition you have seizures and you smoke so evidence does not favor your hypothesis in your case. Sorry, I wish it did stop temporal lobe seizures and then it would become legal. I would start your lamictal as indicated in the package insert. This will decrease side effects. So, what make you think that you have Gerswind syndrome?
Sincerely,
CCF Neuro MD
