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Are Unprovoked Loss Of Consciousness And Tongue Bite Symptoms Of Seizure?
Question: Dear Doctor,
My daughter aged 21 years fell down in her bath room 1-1/2 months back. She was out of her memory (about what happened) for about 20 minutes even on the way to hospital in ambulance. Her room mate heard some crying sound from the bathroom and a plumber broke the bath room door locked from inside. She was lying on the bathroom floor and then immediately taken to the hospital and the Neurologist found no problems in EEG and MRI scan of her brain. There was a bite on her tongue during the incident. It was not a cut on her tongue but a discoloration( appears to be a hard pressing between teeth) on the side of the tongue near her wisdom teeth . The doctor classified it as Idiopathic convulsion and started Levipil 500 morning and evening. She has been having it for the last 1-1/2 months.She is an MBBS 3rd year student now and facing memory problems, mood changes,giddiness, sleepiness, an incident of suicidal attempt by cutting her arm and not ready to appear her exams now. Consulted the same doctor as we saw these types of side effects of this medicine in many websites. But the doctor strongly suggested to continue same dose for 2 years as we should not wait for another seizure. Also he suggested not to change to another medicine as it will give no protection for 7 days and also those medicines have much more side effects . He said he prescribed Levipil 500 for many patients but such side effects are reported. My wife and I are working abroad and our daughter is in the hotel. So we are much worried now.
I kindly request your advice with the following questions.
1) Can it be a case seizure/epilepsy as there is nothing reported in EEG and MRI as well.
2) Does Levipil 500 has such types of side effects
3) Any other alternative to avoid or stop this medicine.
My daughter aged 21 years fell down in her bath room 1-1/2 months back. She was out of her memory (about what happened) for about 20 minutes even on the way to hospital in ambulance. Her room mate heard some crying sound from the bathroom and a plumber broke the bath room door locked from inside. She was lying on the bathroom floor and then immediately taken to the hospital and the Neurologist found no problems in EEG and MRI scan of her brain. There was a bite on her tongue during the incident. It was not a cut on her tongue but a discoloration( appears to be a hard pressing between teeth) on the side of the tongue near her wisdom teeth . The doctor classified it as Idiopathic convulsion and started Levipil 500 morning and evening. She has been having it for the last 1-1/2 months.She is an MBBS 3rd year student now and facing memory problems, mood changes,giddiness, sleepiness, an incident of suicidal attempt by cutting her arm and not ready to appear her exams now. Consulted the same doctor as we saw these types of side effects of this medicine in many websites. But the doctor strongly suggested to continue same dose for 2 years as we should not wait for another seizure. Also he suggested not to change to another medicine as it will give no protection for 7 days and also those medicines have much more side effects . He said he prescribed Levipil 500 for many patients but such side effects are reported. My wife and I are working abroad and our daughter is in the hotel. So we are much worried now.
I kindly request your advice with the following questions.
1) Can it be a case seizure/epilepsy as there is nothing reported in EEG and MRI as well.
2) Does Levipil 500 has such types of side effects
3) Any other alternative to avoid or stop this medicine.
Brief Answer:
Change drug to Valproate or decrease levetiracetam acc to weight
Detailed Answer:
Hello XXXX,
I have gone through your question and understand your concerns.
Unprovoked loss of consciousness with tongue bite may be manifestation of seizure. The investigations like Mri and eeg are not 100% sensitive and treatment require consideration based on clinical history.
The need for drug is bit controversial for first episode of seizure. It is definitely given for first seizure if Mri abnormal or status epilepticus like presentation.
Blood investigations for secondary causes of seizure should be investigated.
In your daughter case the drug may not have been started if she was having someone close to look after any such repeated episode.
Regarding treatment there are many drugs and are given according to weight and increased if required.
Levetiracetam is a good drug with minimal side effects but in some memory and behavioural side effects are intolerable and require either decrease in drug dose or changing to other drug.
Second best choice is Valproate with only problematic side effects like weight gain and polycystic ovarian disease.
As your daughter is very stressed due to inability to carry her studies in medical field I will advise to switch to Valproate 500 mg twice daily with gradually tapering levetiracetam in 8-10 days simultaneously.
You can get an ultrasound abdomen as baseline and consult a neurologist or gynaecologist if menstrual problem arises.
Hope you found the answer helpful.
Do get back to me for further queries.
Regards
Dr Neeraj Kumar
Neurologist
Change drug to Valproate or decrease levetiracetam acc to weight
Detailed Answer:
Hello XXXX,
I have gone through your question and understand your concerns.
Unprovoked loss of consciousness with tongue bite may be manifestation of seizure. The investigations like Mri and eeg are not 100% sensitive and treatment require consideration based on clinical history.
The need for drug is bit controversial for first episode of seizure. It is definitely given for first seizure if Mri abnormal or status epilepticus like presentation.
Blood investigations for secondary causes of seizure should be investigated.
In your daughter case the drug may not have been started if she was having someone close to look after any such repeated episode.
Regarding treatment there are many drugs and are given according to weight and increased if required.
Levetiracetam is a good drug with minimal side effects but in some memory and behavioural side effects are intolerable and require either decrease in drug dose or changing to other drug.
Second best choice is Valproate with only problematic side effects like weight gain and polycystic ovarian disease.
As your daughter is very stressed due to inability to carry her studies in medical field I will advise to switch to Valproate 500 mg twice daily with gradually tapering levetiracetam in 8-10 days simultaneously.
You can get an ultrasound abdomen as baseline and consult a neurologist or gynaecologist if menstrual problem arises.
Hope you found the answer helpful.
Do get back to me for further queries.
Regards
Dr Neeraj Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Sonia Raina
Thanks Doctor for your quick and valuable advice.
Due to the side effects you said for Valproate, my daughter is unwilling to go for it. She is convinced to take Levipil and ready to face the side effects whatever as Levipil is the one with minimum side effects.
Or otherwise if you can propose any other medicine similar to Levipil, kindly advise.
Since she was totally upset due to the upcoming sessionals and university exams,my wife has gone to XXXXXXX and staying now with her. She is basically a girl usually become tensed during her exams even in the school, but this time it is much more. Also now a days she cannot concentrate on studies as well. So we thought it is an effect of the Levipil. Since she could not study the full portion well, she was reluctant to appear the exams even. She wanted to write as supplementary next year after studying the entire portion of all the subjects. But we told her that it will be difficult for her to manage next year portion/exams along with the supplimentaries, we compelled her to write it and so she appeared.
After taking Levipil for a month, doctor asked to go for a blood test(done on 17/10/2015).
Results are as below.
Creatinine (serum) - 0.7 mg/dl ,,,
AST(SGOT)(SERUM) - 13 U/L ,,,,
ALT(SGPT) (SERUM) - 9U/L
Haemoglobin 12.4
WBC - 9500
Platelet - 305000
Neutrophils - 56.4
Lymphocytes - 36.1
Eosinophils - 0.6
Basophils - 0.5
Monocytes - 6.4.
The doctor said the blood reports are normal. So let her continue the medicine for next three months and asked to meet him in Dec 2015. He mentioned that she has to take it for two years.
Regarding dose, wife has already asked the doctor. His reply was her weight is 46 kg. So 500 + 500 mg is the minimum dose for her weight.
Now, I would like ask few more questions.
a) Whether the side effects of Levipil will continue during the entire period of medication? (for the two years or even after)
b) Can the side effects be subsided in few months time as her body may get adjusted with it.
c) Is the minimum duration of medication is two years for Levipil?
d) Can this medicine be stopped before two years?
e)You have mentioned about blood investigations for secondary causes of siezure. Kindly advise me the blood tests to be conducted.
Due to the side effects you said for Valproate, my daughter is unwilling to go for it. She is convinced to take Levipil and ready to face the side effects whatever as Levipil is the one with minimum side effects.
Or otherwise if you can propose any other medicine similar to Levipil, kindly advise.
Since she was totally upset due to the upcoming sessionals and university exams,my wife has gone to XXXXXXX and staying now with her. She is basically a girl usually become tensed during her exams even in the school, but this time it is much more. Also now a days she cannot concentrate on studies as well. So we thought it is an effect of the Levipil. Since she could not study the full portion well, she was reluctant to appear the exams even. She wanted to write as supplementary next year after studying the entire portion of all the subjects. But we told her that it will be difficult for her to manage next year portion/exams along with the supplimentaries, we compelled her to write it and so she appeared.
After taking Levipil for a month, doctor asked to go for a blood test(done on 17/10/2015).
Results are as below.
Creatinine (serum) - 0.7 mg/dl ,,,
AST(SGOT)(SERUM) - 13 U/L ,,,,
ALT(SGPT) (SERUM) - 9U/L
Haemoglobin 12.4
WBC - 9500
Platelet - 305000
Neutrophils - 56.4
Lymphocytes - 36.1
Eosinophils - 0.6
Basophils - 0.5
Monocytes - 6.4.
The doctor said the blood reports are normal. So let her continue the medicine for next three months and asked to meet him in Dec 2015. He mentioned that she has to take it for two years.
Regarding dose, wife has already asked the doctor. His reply was her weight is 46 kg. So 500 + 500 mg is the minimum dose for her weight.
Now, I would like ask few more questions.
a) Whether the side effects of Levipil will continue during the entire period of medication? (for the two years or even after)
b) Can the side effects be subsided in few months time as her body may get adjusted with it.
c) Is the minimum duration of medication is two years for Levipil?
d) Can this medicine be stopped before two years?
e)You have mentioned about blood investigations for secondary causes of siezure. Kindly advise me the blood tests to be conducted.
Brief Answer:
Continue treatment in same doses
Detailed Answer:
Hello XXXX
I will answer all your queries one by one
a) Whether the side effects of Levipil will continue during the entire period of medication? (for the two years or even after)
Ans: Most likely in majority the side effects of drugs decreases with time with better metabolism of drug in body.
b) Can the side effects be subsided in few months time as her body may get adjusted with it.
Ans: Yes , ,more likely the side effect will decrease.
c) Is the minimum duration of medication is two years for Levipil?
Ans: In case of unprovoked or idiopathic seizures the anti epileptics can be stopped only after asymptomatic period of 2-3 years (counted from last seizure episode)
d) Can this medicine be stopped before two years?
Ans:No , not advisable
e)You have mentioned about blood investigations for secondary causes of siezure. Kindly advise me the blood tests to be conducted.
Ans: Most likely the investigations will be normal but for seizure and decreased memory you can get following investigations done blood sugar, calcium, vitamin D3, phosphate, sodium, thyroid profile, vitamin B12.
Other medications can be tried like phenytoin( side effects are more gum hypertrophy, hirsutism and so not suitable in females), phenobarbitone (old drug more side effects ).
Family support is important at present.
My personal view about MBBS: The course is wide and tough and require dedication and it is hard for anyone to cope the pressure of study BUT THE MEDICAL FIELD IS LONG PATH WITH POSTGRADUATION AND SUPER SPECIALITY A NECESSITY SO AT PRESENT SCENARIO IT IS NOT IMPORTANT TO TRY TO READ AND LEARN EVERYTHING BUT READ AS MUCH AS REQUIRED FOR PASSING THE EXAM.
Most of the material read in MBBS is of no significant value when one practice as a specialist.
A good student makes in MBBS and she can pass any hurdle. Don't think about percentages, medals and ranking, it hardly matters in future. The doctor is recognised by his skills , knowledge and patient care not by his medals and certificates.
Hope you found the answer helpful.
regards
Dr Neeraj Kumar
Nurologist
Continue treatment in same doses
Detailed Answer:
Hello XXXX
I will answer all your queries one by one
a) Whether the side effects of Levipil will continue during the entire period of medication? (for the two years or even after)
Ans: Most likely in majority the side effects of drugs decreases with time with better metabolism of drug in body.
b) Can the side effects be subsided in few months time as her body may get adjusted with it.
Ans: Yes , ,more likely the side effect will decrease.
c) Is the minimum duration of medication is two years for Levipil?
Ans: In case of unprovoked or idiopathic seizures the anti epileptics can be stopped only after asymptomatic period of 2-3 years (counted from last seizure episode)
d) Can this medicine be stopped before two years?
Ans:No , not advisable
e)You have mentioned about blood investigations for secondary causes of siezure. Kindly advise me the blood tests to be conducted.
Ans: Most likely the investigations will be normal but for seizure and decreased memory you can get following investigations done blood sugar, calcium, vitamin D3, phosphate, sodium, thyroid profile, vitamin B12.
Other medications can be tried like phenytoin( side effects are more gum hypertrophy, hirsutism and so not suitable in females), phenobarbitone (old drug more side effects ).
Family support is important at present.
My personal view about MBBS: The course is wide and tough and require dedication and it is hard for anyone to cope the pressure of study BUT THE MEDICAL FIELD IS LONG PATH WITH POSTGRADUATION AND SUPER SPECIALITY A NECESSITY SO AT PRESENT SCENARIO IT IS NOT IMPORTANT TO TRY TO READ AND LEARN EVERYTHING BUT READ AS MUCH AS REQUIRED FOR PASSING THE EXAM.
Most of the material read in MBBS is of no significant value when one practice as a specialist.
A good student makes in MBBS and she can pass any hurdle. Don't think about percentages, medals and ranking, it hardly matters in future. The doctor is recognised by his skills , knowledge and patient care not by his medals and certificates.
Hope you found the answer helpful.
regards
Dr Neeraj Kumar
Nurologist
Above answer was peer-reviewed by :
Dr. Sonia Raina
Answered by
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