Post Craniotomy Issues

[saoirse1]

47YO F.Craniotomy 5-12-05 for right frontal convexity meningioma,  Four Issues:1.dilantin withdrawal 2.numb-swelling left wrist & arm  3. bilateral facial parasthesia  4. xanax/ativan concerns.They all sort of interweave.Previously posted 6/2/05 this forum. The "events"described then,  backed off. Dilantin levels found too high for me to tolerate, 21.  Told by NS could  reduce  400 mg to 300 mg, 6/17.   First appt w/ neurologist 6/20.He ordered another EEG  6/22. Said if that came back normal, could begin weaning further off dilantin. N/S concurred. Results good, weaning dilantin from 300 to 200 mg 6/27. Noticed felt slight anxiety with weaning, mild tremor. Back to work 1/2 time 7/05.  Began around this time to have a different sort of numbness in left wrist/part of hand /arm, along with swelling in wrist, pain. Seemed activity related.Was in p/t for this arm,very weak post surgery.

Saw PCP 7/06. RX lodine,advised cease exercises 2 weeks. Med helped. Finished lodine, symptoms returning.

Had noted mild itching during  dilantin weaning. 7/07 increased itching,rash. Told stop dilantin.Just about to reach 100 mg level  Told "bridge med" not necessary. Had also some bilateral facial numbness, told facial parasthesia,should pass. Lasts most of day. Lodine seemed to help this as well.  Discontinuation /withdrawal symptoms from dilantin began 7-10 : increasing anxiety, shakiness, escalating to panic. Had been taking xanax since tumor DX, concern increasing, continuing long term,or sudden stop. Called neuro,he agreed.  RX ativan 1 mg 2x day. Helps slightly.Post dilantin EEG 8-17.

[CCF-Neuro-M.D.-PW]

Its not entirely clear what your question is



If you have not had a seizure or abnormal EEG in the past, an anti-epileptic drug is not routine practise to take on  chronic basis. A few weeks after surgery may be appropriate, although not proven to benefit. It seems like your dilantin was being weaned off relatively slowly as appropriate - in this case it does not tend to cause such withdrawal symptoms.



The cause for your paresthesias and anxiety symptoms may not be due to dilatin withdrawal but may be a primary anxiety or related to another medication. Ativan and other benzodiazepine are ok for the short term treatment of anxiety, but should not be used for longer than 2-3 weeks, as these medication aer addictive, lose their effect over time, and may delay finding the underlying cause of the anxiety which may need to be addressed for resolution of your problem. The symptoms do not sound like any form of seizure.



Good luck

[saoirse1]

Thank for your response. My  apologies if the 4 numbered concerens were not presented with proper clarity. Might have been the character-limit placed on queries.



As for #1-Dilantin withdrawal symptoms. I was assured after this post that indeed there are discontinuation symptoms, just as I described. This by my NS , neurologist, PCP, and a highly regarded pharmaceutical expert. Those symptoms have abated, I am grateful for that.



As for your mention of "chronic use",that was never how I was prescribed the dilantin. Sorry if that is how the post presented    I had, as mentioned in the 6/2 post, what I was told to be a sensory seizure 4/20/05. Thought at first to be a stroke. Almost entire left side went "dead".  Many careful tests later at Presbyterian Hospital here in NC indicated no stroke. MRI indicated the meningioma.



2. Left arm swelling/pain/numbness:  Was looking for possible suggestions as to further tests I might bring up at f/u appointment. That arm has been used more than usual in regaining full use of it after the surgery.  



3. Bilateral facial parestesthesia. I did not think it was from the dilantin discontinuation, nor was that ever suggested. It is not from anxiety.  It is across the entire chin, and into my face. Reamins most of the day.  As I said i was told it is not unusual to have these sorts of paresthesias after this sort of surgery. Just wondered if the forum md  had suggestion for another possible cause before my next f/u visit.



Again, my thanks for taking the time to answer.