epilepsy/depersonalization

[medco]

i was diagnosed with temporal lobe epilepsy 5 years ago. following my second seizure, i was put on paxil for panic attacks due to fear of having another seizure. i've been relatively fine until 4 weeks ago, when i experienced an aura. it lasted 2 seconds, but it brought all the fear back that i had when i was first diagnosed with epilepsy 6 years ago. i've been taking ativan and have re-started the paxil. i take 1000mg of tegretol once a day. in addition, i have been having extreme feelings of depersonalization. like i am living in a dream, feeling as though i am not real. i've always had these feelings, but they have recently become heightened. what should i do? i've read that lamictal may help alleviate these feelings of depersonalization.

also, i just started having these burning/pins and needles/tingling sensations in my extremities which sometime occur in my head and chest. could this be the start of mad cow disease vCJD? i've never been to Britain, nor have I ate the brain or spine of a cow. from what i can remember, i've never had a t-bone steak either. but the recent anxiety and pins and needles sensations have started to scare me! thanks.

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

First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
   Temporal lobe epilepsy can cause memory problems, personality changes, feelings of depersonalization, language problems and/or hallucinations/psychosis in addition to more typical seizures.  These problems are due to temporal lobe dysfunction often related to the underlying cause of the epilepsy.  First I would recommend that you get an extended EEG, such as a 2 hour sleep deprived or a 24-72 hour EEG to assess your inter-ictal activity (Spikes, etc) and evaluate you for possible seizures.  I would also recommend that you switch to an extended release Tegretol(XL or CR) or Carbatrol, and split your dose to twice per day.  This will keep a more constant level of drug and decrease your chance for another seizure.  If this does not stop the seizures, you may need to switch to another drug such as trileptal, lamictal, keppra, topamax etc.  If you fail 2-3 drugs then you may be a candidate for epilepsy surgery (Which requires a workup including MRI, Epilepsy monitoring unit stay, PET scan, neuro-psych eval, and often invasive monitoring).  
    The symptoms you describe are NOT consistent with CJD.  Patients with CJD develop rapid onset and progressive (over 6months~2years) dementia, myoclonic jerks, and aphasia.  Testing for CJD includes lumbar puncture for 14-3-3 protein, MRI Brain, EEG and possible biopsy (tonsil or muscle for vCJD, brain for other CJD).
I hope this has been helpful.

[medco]

sorry, just to correct myself. i was put on tegretol for my temporal lobe epilepsy 5 years ago when it began. and i take 1200mg of tegretol a day, 600mg twice a day in the morning and at night.