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1475202 tn?1536274577

Cirrhosis/Peripheral neuropathy

I also posted this in the neurology group and haven't heard any replies so maybe it fits here as well.

Peripheral neuropathy has been my diagnosis since October 2010. My brain has tiny seizures one after another 24/7. They are so small I don't feel them. This was due to alcoholism and a diagnosis of end stage cirrhosis 03-23-10.

Due to the condition of my liver I need to be very cautious with the medication I take. Gabapentin is the only medication I can take to address the neuropathy since all of the others metabolize in the liver. Due to the side effects of the medication (insomnia, mood swings and anger) I would like to discontinue the use of it. I sleep 4 to 6 hours per night and feel well rested but I worry that it might not be healthy for my liver to sleep so little. I know my neurologist will need to taper me off of the medication but I worry the most that I increase the risk of a more severe seizure? If so what could I expect?

I realize this is probably a question for my neurologist but with hepatic encephalopathy I'm not always quick to think of the right questions. Thank you for any suggestions. My dosage is 300mg twice daily. I have tried reducing it by half for one week and noticed no change so I increased back to the prescribed dosage since my conserns of a more severe seizure.

Randy
8 Responses
Avatar universal
MEDICAL PROFESSIONAL
Hello and hope you are doing well.

The seizure activity needs to be controlled with medications. Repeated convulsions can cause hypoxemia (decreased oxygen) supply to the brain, hence they need to be controlled. So, please do not venture to discontinue your medication. You may just need constant evaluation to see that the medication is adequate and there are no untoward side effects on the liver. At regular intervals have liver function tests done. Please discuss this with your doctor am sure he will provide further assistance.

Hope this helped and do keep us posted.
1475202 tn?1536274577
Thank you very much for your reply. Are you familiar with any other options for treatment with the exception of using drugs that metabolize in the liver? Is Gabapentin the only option I have?
Avatar universal
MEDICAL PROFESSIONAL
Hello Sir and hope you are doing well.

Understand your predicament. But seizure activity is spontaneous electrical activity, which is initiated from a focus in the brain. This activity needs to be suppressed to control seizures. So, anti convulsive medications will have drowsiness or mood swings as side effects. But with time you may develop tolerance to these side effects. If this medication is effective in controlling seizures and your liver enzymes are not showing a progressive increase, your doctor will advise you to continue the same. You can participate in user reviews of this medication to gain more insight.

Hope this helped and do keep us posted.
1475202 tn?1536274577
I spoke with a lady at my gastrologists office who in turn explained my situation to the Dr. and then two days later I recieved a call back informing me to reduce the medication by half.

I think that will really help and since no EEG has been scheduled my doctor must be extremely confident that the 300mg (vs. 600mg.) dosage will be effective in controling the seizures and I now have nothing to worry about. So any poor use of grammer or spelling errors in my next reply please discard, im doing fine. Ha ha!

Randy
1475202 tn?1536274577
So approximately 3 hours ago I got a phone call from my neurologist's office again instructing me to discontinue the medication immediately. I am instructed to report how I’m feeling after a couple of days. Surprised by this action I researched Gabapentin and found the following information listed near the bottom of the drug fact page:

You, your family, or your caregiver should call your doctor right away if you experience any of the following symptoms: panic attacks; agitation or restlessness; new or worsening irritability, anxiety, or depression; acting on dangerous impulses; difficulty falling or staying asleep; aggressive, angry, or violent behavior; mania (frenzied, abnormally excited mood);

You can find this information at:

PubMed Health
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000940/

I take a lot of medications and I read the drug sheets on each one before starting something new but as you probably know it's difficult to remember. I still am concerned with having a more severe seizure but it will be good to be back to my old self. Thank you for helping.

Randy
Avatar universal
MEDICAL PROFESSIONAL
Hello and hope you are doing well.

Understand your predicament. But all medications do have side effects and they need constant monitoring. Having discontinued the medications the risk of seizures may be there. You could have a repeat EEG to monitor the progress of seizure activity. If the minor activity is progressing, your doctor may re start a seizure medication. If not he may wait and watch. Also, simultaneously monitor your liver function tests. In the meantime enjoy your 'happy self'...:)

Hope this helped and do keep us posted.
1475202 tn?1536274577
Since my last response I have returned to my normal happy self! :) I don't understand my neuroligist's thinking since he has no concerns to run another EEG since discontinuing the medication. I have great medical insurrance so that's not a concern he should have.

There are only two neurologists in the city I live in. My first appointment with him he kept going on about how busy he is and so I finally asked him if he can help me or not? lol

Would you recomend another EEG? I'm sure somehow I could make it happen if it's necessary. Im just trying to figure out what's the best move from here at least another appointment or perhaps the other neurologist.
Any suggestions for me?

Oh and welcome back!
Randy
Avatar universal
MEDICAL PROFESSIONAL
Hello and good you are doing well.

With any neurologist, he will need an EEG to study the seizure activity. My concern is why is there seizure activity in the first place. Late onset or adult onset seizures have a definite cause, like say tumors. I am not sure if impending hepatic encephalopathy or the effects of liver failure on the brain can produce such a picture in the EEG. Along with controlling seizures, the cause for the same needs to be handled. Also, as you have not exhibited any seizure activity, your doctor may be weighing the pros and cons of therapy for seizures. If you are at high risk for seizures, your neurologist would have re started you on medication. Now, you need to ask your neurologist about the cause for this activity and a follow up EEG to know the present status, if not anything you will be more assured. Take Care

Hope this helped and do keep us posted.
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