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Posted by ccf neuro M.D. on May 08, 1997 at 17:55:24:
In Reply to: First Time Seizure posted by RobC. on May 05, 1997 at 20:53:46:
: I am a 34 year old who had my first seizure of life on April 16,1997. Just prior to my seizure, my left quadracep muscle began to spasm. I was mowing my lawn at the time and thought the spasm was normal muscle strain. The spasm subsided but about 10 seconds later my left knee began to wobble uncontrollably. Almost immediately my left quad again began to spasm. Shortly thereafter, my entire left side seized and I became unconscious before I hit the ground. Witnesses tell me my head hit the street when I fell, however, I do not believe this caused any blunt trauma. I was unconscious for approximately 15 minutes but not alert or oriented for approximately 40 minutes. My first recollection after seizing was being lifted from an ambulance to a helicopter for a flight to a trauma unit. In the trauma unit I was given a head CT which was read as normal. My cranial nerve exam and all blood tests were reported as normal. The following day, I was given a brain MRI and an EEG which were also reported as normal. My Treating neurologist initially prescribed Dilantin, but I was switched the following day to Tegretol upon a determination my two prior broken jaws and significant dental history could be affected by the Dilantin. I was weaned upward on the Tegretol and am now on my proper dosage of 800mg per day. I take 400mg of Tegretol XR 12 hours apart each day. My initial blood work indicates my Tegretol level is 10.8 and my liver function is normal. Initially, the Tegretol caused significant dizziness and drowsiness. My diziness has subsised but I still become drowsy after taking the drug. My questions arise out of symptoms that began yesterday. I began to notice involuntary "jerking" or movement of both hands at work. This symptom is not consistent but happened on and off for the better part of the day. Additionally, my left and right legs have what I feel is muscle pain, however, it is unusual because it comes and goes and when it is present it is a sharp pain. I also have pain in my left upper arm. The involuntary movement and unexplained muscle pain is highly disconcerting as I am new to seizure disorder. Would the medication be causing these new symptoms or could it be the disorder? My neurologist is away for several days and her resident has not gotten back to me. Is this something I should be concerned about? I would appreciate your comments.
Sudden, brief, single, lightning-like jerks of parts of the body are known as myoclonus, and may be associated with an underlying seizure disorder. The most common specific form of epilepsy it is seen with is known as juvenile myoclonic epilepsy, typically starting in the teenage years and often it runs in families. As a first time seizure sufferer in midadulthood, the chances of there being an underlying structural cause such as a brain tumor or scar on the brain. In your case, if your MRI was normal as well as your EEG, it is unlikely you have a tumor. Perhaps whatever trauma caused your two prior broken jaws may have caused a scar in your brain that is generating the seizures. Rarely, infectious diseases like chronic meningitis or inflammatory diseases that can also cause meningitis (noninfectious) can cause seizures. There are also some extremely rare degenerative disorders of the brain that can present with symptoms of seizures and myoclonus, such as Creutzfeld-Jakob disease. Tegretol at therapeutic
doses often causes a feeling of drunkenness, especially when first starting it. It can also cause unsteadiness, double vision, and occasionally jerkiness and incoordination of the hands when attempting to move them. It does not typically cause myoclonus. I would definitely report the symptoms to your neurologist and, especially if they persist, be rechecked and/or have a repeat Tegretol level performed. If you live anywhere near Cleveland, the Cleveland Clinic has one of the foremost epilepsy centers in the entire world. An appointment to see one of our epileptologists could be made by calling 216-444-5559, or 1-800-223-2273 ext. 45559
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