Advice from Group about Lamictal and Zonegran

[Guest guest]

Hello to Everyone,

I need the group's advice on the advisability of switching the medication

from Lamictal to Zonegran.

My son (age 22) has experienced tonic-clonic seizures since age 18.

Tomorrow will be his 4th " anniversary " with E.

Currently, he is on 500 mg. of Lamictal. Previously, he had been on

Depakote and Phenytek,( and tried Keppra for a week but could not tolerate

the side effects). He has gone as long as 18 months seizure free on the

Depakote and 14 months on the Phenytek. He's been on Lamictal since March

and was seizure free on it for 4 months, but since then he's experienced 4

TCs, the most seizures he has ever had on any medication. The initial dose

(after titration) was 300 mg, which was raised to 400 mg and then

increased again to 500 mg. when the seizures occurred. Unfortunately, he

had another TC seizure on Friday while on the 500 mg. dose.

He now doesn't think that Lamictal will ever work for him and asked his

epileptologist to be switched to another AED. He was prescribed Zonegran. I

read the PI for it and am extremely concerned about the potential side

effects of this drug, especially the cognitive slowing.

My thought is that he should continue on Lamictal, but raise the dose to

600 mg and see if it works. He is able to tolerate this drug very well even

at 500 mg. For some reason, his serum levels were dropping even tough the

dose was being increased. However, the last two readings were in the 10

range, so it seems to have stabilized.

I suspect that 600 mg. Lamictal would work given the unusual nature of the

seizure he experienced on Friday. It was atypical in that;

(1) his aura lasted for 2 hours (usually, it is only a matter of a few

minutes),

(2) he did not bite his tongue as he typically does, which suggests to me

that the seizure was extremely brief (perhaps just the tonic phase and no

clonic movements),

(3) he did not have a headache afterwards, which again is something he

always experienced in the past.

I like to interpret the last seizure terms of the analogy of trying to

start a car on a cold day. The Lamictal, like cold weather, was preventing

the aura (a simple partial seizure) from " turning over " into a

generalized seizure, despite numerous attempts to start. Even when it did

turnover, it could not stay on for long and died very quickly because of

the Lamictal (which acts like the low temperature in my car analogy).

His neurologist seems to agree with this interpretation and told my son

that Lamictal " almost worked " , but he is nonetheless going along with my

son's wishes. I consider the AED switch to be a mistake. I read in a

number of sources that for people who failed 2 or more AEDs, the more

optimal course of action is to push an AED to its maximum dosage (until

toxicity occurs) rather than trying another one.

I'm hoping get the benefit of the group's experiences on this matter. Do

you think I'm correct in my thinking that the drug seems to be working to

some extent? Also, has anyone here had experiences with Zonegran?

Thank you for your thoughts.

Best regards,

[Guest guest]

As yet, I haven't heard from anyone about my request for comments about

the situation described below. Therefore, I'm remailing. I really do want

the group's opinion on this.

Thanks,

Mike

Roszkowski

<roszkows@lasalle To

.edu>

Sent by: cc

@yah

oogroups.com Subject

[ ] Advice from Group

about Lamictal and Zonegran

10/31/2006 06:46

PM

Please respond to

@yah

oogroups.com

Hello to Everyone,

I need the group's advice on the advisability of switching the medication

from Lamictal to Zonegran.

My son (age 22) has experienced tonic-clonic seizures since age 18.

Tomorrow will be his 4th " anniversary " with E.

Currently, he is on 500 mg. of Lamictal. Previously, he had been on

Depakote and Phenytek,( and tried Keppra for a week but could not tolerate

the side effects). He has gone as long as 18 months seizure free on the

Depakote and 14 months on the Phenytek. He's been on Lamictal since March

and was seizure free on it for 4 months, but since then he's experienced 4

TCs, the most seizures he has ever had on any medication. The initial dose

(after titration) was 300 mg, which was raised to 400 mg and then

increased again to 500 mg. when the seizures occurred. Unfortunately, he

had another TC seizure on Friday while on the 500 mg. dose.

He now doesn't think that Lamictal will ever work for him and asked his

epileptologist to be switched to another AED. He was prescribed Zonegran. I

read the PI for it and am extremely concerned about the potential side

effects of this drug, especially the cognitive slowing.

My thought is that he should continue on Lamictal, but raise the dose to

600 mg and see if it works. He is able to tolerate this drug very well even

at 500 mg. For some reason, his serum levels were dropping even tough the

dose was being increased. However, the last two readings were in the 10

range, so it seems to have stabilized.

I suspect that 600 mg. Lamictal would work given the unusual nature of the

seizure he experienced on Friday. It was atypical in that;

(1) his aura lasted for 2 hours (usually, it is only a matter of a few

minutes),

(2) he did not bite his tongue as he typically does, which suggests to me

that the seizure was extremely brief (perhaps just the tonic phase and no

clonic movements),

(3) he did not have a headache afterwards, which again is something he

always experienced in the past.

I like to interpret the last seizure terms of the analogy of trying to

start a car on a cold day. The Lamictal, like cold weather, was preventing

the aura (a simple partial seizure) from " turning over " into a

generalized seizure, despite numerous attempts to start. Even when it did

turnover, it could not stay on for long and died very quickly because of

the Lamictal (which acts like the low temperature in my car analogy).

His neurologist seems to agree with this interpretation and told my son

that Lamictal " almost worked " , but he is nonetheless going along with my

son's wishes. I consider the AED switch to be a mistake. I read in a

number of sources that for people who failed 2 or more AEDs, the more

optimal course of action is to push an AED to its maximum dosage (until

toxicity occurs) rather than trying another one.

I'm hoping get the benefit of the group's experiences on this matter. Do

you think I'm correct in my thinking that the drug seems to be working to

some extent? Also, has anyone here had experiences with Zonegran?

Thank you for your thoughts.

Best regards,