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Having Lupus. Having Fever And Body Pain. Diagnosed Damage In Nerve System. Prescribed Eptoin, Acitron And Fezium. Guidance

Posted on Thu, 18 Jul 2013

Question: Hi, this query is about my 21 years old sister. She is a patient of Lupus and she is on medicines for last 8 years. 8 years back lupus started with fever, body pain. She started getting fits after a year.
After first 2 years, she was hospitalized in AIMS for around 6 months and finally started recovering. Doctors confirmed some damage (in a layman term) in nerve system (brain) with lupus. I remember few medicine names she was on like Eptoin, Acitron, Fezium etc.
We are having follow-ups with our Rheumatologist once every 3 months. He says she has almost (99%) recovered on lupus and there is nothing to worry as of now.
The issue which is bothering us is, she gets complain of stomach ache and vomiting once in every five-six months. This stays for 10 to 15 days (during this duration local Doctors treats her with Glucose and some other common treatments) and gets cured automatically after 10 - 15 days. I really need to know “what’s the problem now because of which she gets Stomach ache and vomiting for 10 – 15 days after every six months” Please guide us towards better treatment.
Thanks.

Answered by Dr. Sudhir Kumar (21 minutes later)

Hi,

Thank you for posting your query.

I am glad to know that your sister's lupus is under good control, and more than 99% in remission (no symptoms of lupus).

Seizures do occur in patients with lupus, as lupus affects multiple body parts including brain.

Her symptoms of stomach ache and vomiting could be related to gastro or neuro problem. I am sure she would have had ultrasound/CT abdomen and endoscopy during those episodes. If the gastro check up was normal, then these symptoms could represent neuro problem, such as cyclical vomiting syndrome. It could also be due to abdominal epilepsy/fits.

I see that she is on eptoin (phenytoin), however, looking at her symptoms, Tegrital (carbamazepine) or Oxetol (oxcarbazepine) may be preferable.

I hope it helps. Please get back if you have any more queries.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, Hyderabad

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (1 hour later)

Complain of Seizures has gone down in last 2 – 3 years. In-fact there was no Seizures for last 1 year. Only Stomach ache and vomiting is creating trouble in her life.

Yes she had ultrasound and endoscopy at AIMS and Gastroenterologist from AIMS confirmed there is no issue. We also suspect for some neuro issue as gastero confirmed the reports normal.

She is having Eptoin from 2005, started with 100 mg, increased to 200 mg and currently on 300 mg for last 5 years. I really need your opinion on “what it could be?” and how to get this cured?

Answered by Dr. Sudhir Kumar (21 minutes later)

Thank you for getting back with more details.

It is good to note that her gastro check up was normal.

Then, we are dealing with neuro problem, as described above. To confirm the diagnosis, please get an EEG test done, when she develops stomach pain and vomiting next time. As suggested earlier, treatment with Oxcarbazepine or carbamazepine would be helpful.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (21 minutes later)

Thanks doctor. Your opinion is really helpful in reducing the stress.

Yes we shall go for EEG and will come back to you with the reports.

I appreciate your support.

Thanks

Answered by Dr. Sudhir Kumar (6 hours later)

Sure. Please keep me informed about her EEG report and further progress.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar