Stopping seizure meds when not seizure free in elderly

My husband has been having grand mal seizures about every 6-7 weeks since having a stroke 8 months ago. They started 3 mos post ICB.  We have tried med after med with nasty side effects causing us to have to eliminate them. He is currently on the least nasty one, Gabapentin, but it isn't controlling the seizures. Yesterday the neurologist added topamax. I was to give 25 mg at bedtime and gradually taper up to 100 mg bid. I was to continue the gabapentin at 300 mg tid.  On gabapentin, if I give 100 mg less than the prescribed dose in the am, we get about 3 hours of quality awake time in the afternoon. The rest of the time, he is just a lump in a wheelchair.  After giving the topamax at bedtime last night, he has not been awake enough to even eat.  No med has left him able to participate effectively in physical therapy and continue what, before the seizure meds, was good progress toward regaining use of his arm and leg.  My husband would not want to live this way. If he could come out of the med induced confusion, I am sure he would opt for a potentially shorter but enjoyable life over a longer life as a potato in a chair.  I am faced with the decision of whether or not to allow him to wake up and know that he is alive, (and risk seizures)  or leave him in limbo but seizure free. Can you give me any advice or resource material that can help me with this. Right now, I even have to remind him to put food in his mouth, chew it, and swallow it. After his early seizures (with test results that indicated no seizure activity) but before his med, he was just beginning to walk with a cane.

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

I am sorry to hear about your husband’s difficulties. Seizures after having a stroke are common. I am not sure what all meds your husband has tried, but there are many seizure medications available. Topiramate does carry the risk of causing forgetfulness/confusion. Gabapentin most commonly causes drowsiness and dizziness. I would suggest that you have your husband and you discuss what medications have been trialed, what the side effects were, and what medications are remaining to be tried. If he continues to have breakthrough seizures despite adequate medication trial, he may need a referral to an epilepsy center for more thorough investigation/management.

Additionally, depression after a stroke is common too. I would suggest that your husband be evaluated for this.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.