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What Are The Side Effects Of Levipil And Zentel For Epilepsy?
Posted on
Sat, 17 Jan 2015
Medically reviewed by
Ask A Doctor - 24x7 Medical Review Team
Sat, 17 Jan 2015
Answered on
Mon, 16 Feb 2015
Last reviewed on
Question : I got seizures thrice first time in Feb 2008, second time in July 2012 and third time in Sept. 2014. I had MRI of brain 7 times and CT scan twice. Consulted about 6 doctors in the past 7 years. Initially they said it is Acute Infarct in left temporal region. Then they said it is Brain TB for which I was on strong antibiotics. Later they said it is NCC. I am a vegetarian. I was prescribed with Zentel and Eptoin tablets. Now I am taking Levipil 2 gr. per day. Whenever there is a seizure I had MRI showing the spot and oedema. After 2-3 months the oedema coming down and doctor said it got calcified in Dec 2012. But I got seizure in Sept 2012 and MRI has shown that oedema appeared. Again I took Zentle for two months and latest MRI in Dec 2014 shows that the oedema has gone and it is partially calcified. The doctor advised to take CT scan after 6 months to verify whether it got completely calcified. However, he said I may have to use Levipil 2 gr. per day next 3 years and if necessary for the rest of my life. Presently I am 60 years old. I getting aggression, tension and sometimes depression, sleeplessness. What are the side effects please. My job involves lot of brain work as I have to hear the arguments made in the court, read the files and pronounce judicial pronouncements. Please advise me
Brief Answer:
Levipil is the safest antiepileptic drug. Can cause behavioural changes.
Detailed Answer:
Hi,
Thanks for being on Healthcaremagic.
I am Dr.Ajay Panwar, a neurologist, here to answer your query.
If you would have presented to me as an outpatient, my advise to you would have been-
Please be reassured. There have been many eminent personalities who spent their lives with epilepsy and reached the epitome of success like-Albert einstein and Jhonty rhodes to name a few.
Unless you upload your successive MRI images and reports, it is hard for me to pin-point your cause for epilepsy. However, it appears that it is a granuloma in brain parenchyma(likely Neurocysticercosis) with perifocal edema, that has been the culprit in your case. If your seizures are well controlled with Levipil, then you can safely continue with it as it is the safest antiepileptic in today's neurological practice. However, about 1 in 500 individuals who use it may report some mental behavioural changes, personality changes, excessive aggression or irritability or suicidal tendencies. If you start noticing some of these changes, then you should bring it to the notice of your treating doctor. In that case, this drug needs to be substituted by some other drug.
Bottom line is that please continue the medicines, making it as a habit of your daily routine. Give it the same importance as you give to important everyday tasks like eating or bathing. Don't fear as it is one of the safest drug to treat epilepsy, with a word of caution ' bring it to the notice of your doctor if you ever have some mental or behavioural changes'. Continue the medicines for atleast consecutive 2 years of seizure-free interval.
Hope I have answered your query. If you have further queries, I shall be glad to answer else, please close the thread-rate it and write a review.
Dr.Ajay Panwar,
MD,DM(Neurology)
Levipil is the safest antiepileptic drug. Can cause behavioural changes.
Detailed Answer:
Hi,
Thanks for being on Healthcaremagic.
I am Dr.Ajay Panwar, a neurologist, here to answer your query.
If you would have presented to me as an outpatient, my advise to you would have been-
Please be reassured. There have been many eminent personalities who spent their lives with epilepsy and reached the epitome of success like-Albert einstein and Jhonty rhodes to name a few.
Unless you upload your successive MRI images and reports, it is hard for me to pin-point your cause for epilepsy. However, it appears that it is a granuloma in brain parenchyma(likely Neurocysticercosis) with perifocal edema, that has been the culprit in your case. If your seizures are well controlled with Levipil, then you can safely continue with it as it is the safest antiepileptic in today's neurological practice. However, about 1 in 500 individuals who use it may report some mental behavioural changes, personality changes, excessive aggression or irritability or suicidal tendencies. If you start noticing some of these changes, then you should bring it to the notice of your treating doctor. In that case, this drug needs to be substituted by some other drug.
Bottom line is that please continue the medicines, making it as a habit of your daily routine. Give it the same importance as you give to important everyday tasks like eating or bathing. Don't fear as it is one of the safest drug to treat epilepsy, with a word of caution ' bring it to the notice of your doctor if you ever have some mental or behavioural changes'. Continue the medicines for atleast consecutive 2 years of seizure-free interval.
Hope I have answered your query. If you have further queries, I shall be glad to answer else, please close the thread-rate it and write a review.
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
Hi Doctor,
Thank you very much for your analytical answer. Once the MRI report in Dec 2012 made it clear that the edema has disappeared and the spot got calcified then why I got seizure in Sept 2014 though I was taking Levipil regularly? The MRI of Sept 2014 has shown that edema has reappeared. I was 100 % sure from Dec 2012 onwards that I will not get seizure again. The doctor also said the same in Dec 2012. I went to different places and travelled to USA alone and my last trip to USA was XXXXXXX 2014 and I got seizure in Sept 2014 and I collapsed while walking in our complex. Had it occurred during my travelling alone or driving my car it would have landed me in difficult situation and even might have become fatal. When I got seizure in Sept 2014 the doctor was shocked and he could not clarify my doubts properly. After increasing the dose of Levipil and after taking Zenle 400 mg 200 tablets I got latest MRI done in Dec 2014 wherein the edema disappeared and the radiologist/doctor said it got calcified partially. If in Dec 2012 itself it was concluded that it got calcified then why it should reappear and now the same radiologist and doctor say that it partially calcified. Therefore I fear that after one or two years I may again develop edema and may get seizure though I am regularly taking Levipil. Nobody is assuring me that I may not get seizure again. It is getting repeated. I travel alone in XXXXXXX and abroad as both my children are residing abroad. I drive my personal car though I have got driver for my official car. Am I required to go for MRI every year whether I get seizure or not to satisfy myself that there is no edema and I don't have risk of getting seizure and I can travel alone or drive vehicle. I shudder of thinking of going for MRI again again as it is excruciating. Please clarify doctor.
Thank you very much for your analytical answer. Once the MRI report in Dec 2012 made it clear that the edema has disappeared and the spot got calcified then why I got seizure in Sept 2014 though I was taking Levipil regularly? The MRI of Sept 2014 has shown that edema has reappeared. I was 100 % sure from Dec 2012 onwards that I will not get seizure again. The doctor also said the same in Dec 2012. I went to different places and travelled to USA alone and my last trip to USA was XXXXXXX 2014 and I got seizure in Sept 2014 and I collapsed while walking in our complex. Had it occurred during my travelling alone or driving my car it would have landed me in difficult situation and even might have become fatal. When I got seizure in Sept 2014 the doctor was shocked and he could not clarify my doubts properly. After increasing the dose of Levipil and after taking Zenle 400 mg 200 tablets I got latest MRI done in Dec 2014 wherein the edema disappeared and the radiologist/doctor said it got calcified partially. If in Dec 2012 itself it was concluded that it got calcified then why it should reappear and now the same radiologist and doctor say that it partially calcified. Therefore I fear that after one or two years I may again develop edema and may get seizure though I am regularly taking Levipil. Nobody is assuring me that I may not get seizure again. It is getting repeated. I travel alone in XXXXXXX and abroad as both my children are residing abroad. I drive my personal car though I have got driver for my official car. Am I required to go for MRI every year whether I get seizure or not to satisfy myself that there is no edema and I don't have risk of getting seizure and I can travel alone or drive vehicle. I shudder of thinking of going for MRI again again as it is excruciating. Please clarify doctor.
Brief Answer:
Even calcified focus can cause seizure.A calcified spot can't decalcify.
Detailed Answer:
Hi XXXXXXX,
Thanks for being in follow-up.
Thanks for providing your detailed medical history.I again want to reassure you and simultaneously I am afraid to say that my opinion differ from the one of your treating doctor on 'seizure causing ability of calcified focus'.Though he probably told you that,once a granuloma gets calcified,it is unlikely to cause seizure,but many of the medical research studies have proved that even calcified foci have propensity to cause seizures.In other words,calcium as a mineral has the tendency to irritate neurons of the brain parenchyma,thus causing seizures.However,it is true that 'calcified spots' have much lesser chances of causing seizures as compared to 'active granuloma'.
Another issue to address is of confusion between 'calcification status of granuloma' between the two MRI(DEC 2012 vs DEC 2014). What is definite here is that 'Once a lesion gets calcified,it can't decalcify'.So,if it is partially calcified in DEC 2014 MRI,there is no doubt about it that it was at the most partially calcified in DEC 2012 also.Otherwise,also calcification is a process that may take years.It must have been a radiologist's confusion,then in 2012-reporting it to be a completely calcified lesion.
My advice-Please continue regular antiepileptic medicines till 2 years of seizure-free interval.If you remain seizure free for next two years,please do a repeat MRI and Electroencephalogram(EEG)after two years,and discuss with your doctor to start tapering the drugs then.
Hope I have answered your query.If you still have follow-up queries,I shall be glad to answer,else please close the thread-rate it and write a review.
Dr.Ajay Panwar,
MD,DM(Neurology)
Even calcified focus can cause seizure.A calcified spot can't decalcify.
Detailed Answer:
Hi XXXXXXX,
Thanks for being in follow-up.
Thanks for providing your detailed medical history.I again want to reassure you and simultaneously I am afraid to say that my opinion differ from the one of your treating doctor on 'seizure causing ability of calcified focus'.Though he probably told you that,once a granuloma gets calcified,it is unlikely to cause seizure,but many of the medical research studies have proved that even calcified foci have propensity to cause seizures.In other words,calcium as a mineral has the tendency to irritate neurons of the brain parenchyma,thus causing seizures.However,it is true that 'calcified spots' have much lesser chances of causing seizures as compared to 'active granuloma'.
Another issue to address is of confusion between 'calcification status of granuloma' between the two MRI(DEC 2012 vs DEC 2014). What is definite here is that 'Once a lesion gets calcified,it can't decalcify'.So,if it is partially calcified in DEC 2014 MRI,there is no doubt about it that it was at the most partially calcified in DEC 2012 also.Otherwise,also calcification is a process that may take years.It must have been a radiologist's confusion,then in 2012-reporting it to be a completely calcified lesion.
My advice-Please continue regular antiepileptic medicines till 2 years of seizure-free interval.If you remain seizure free for next two years,please do a repeat MRI and Electroencephalogram(EEG)after two years,and discuss with your doctor to start tapering the drugs then.
Hope I have answered your query.If you still have follow-up queries,I shall be glad to answer,else please close the thread-rate it and write a review.
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Prasad
Thank you very much doctor. You are the first doctor to clarify the things clearly . I am fully satisfied with the way you responded and cleared my doubts without seeing either me or my record. However, Please enlighten me on the following.
1. Whether I should continue to take the high dose of 2 gr. Levipil per day @ 1 gr. in the morning and one gr. in the evening as there my be some side effects.
2. If I forget or delay to take medicine even in one session due to my busy schedule or due to on travel, is there any chance of getting seizure?
2. Does it become an addiction to take such high dose continuously?
3. Can I travel alone or drive vehicle. Of course, by taking the dose regularly?
4. Am I required to go for CT scan after another 6 months to fully satisfy that it got calcified as the doctor treating me said that CT scan is better than MRI to know whether it calcified or not.
5. I have already undergone CT Scan twice and & MRI 7 times. I was informed that there are chances of radiation induced brain tumours with CT scan. Is it correct doctor?
Kindly clarify my doubts.
Thank you very much
1. Whether I should continue to take the high dose of 2 gr. Levipil per day @ 1 gr. in the morning and one gr. in the evening as there my be some side effects.
2. If I forget or delay to take medicine even in one session due to my busy schedule or due to on travel, is there any chance of getting seizure?
2. Does it become an addiction to take such high dose continuously?
3. Can I travel alone or drive vehicle. Of course, by taking the dose regularly?
4. Am I required to go for CT scan after another 6 months to fully satisfy that it got calcified as the doctor treating me said that CT scan is better than MRI to know whether it calcified or not.
5. I have already undergone CT Scan twice and & MRI 7 times. I was informed that there are chances of radiation induced brain tumours with CT scan. Is it correct doctor?
Kindly clarify my doubts.
Thank you very much
Brief Answer:
You should not miss antiepileptic dose.Don't drive yourself for now.
Detailed Answer:
Hi XXXXXX,
Thanks for being in follow-up.
You are welcome for the day.
Thanks for appreciating the response.Answers to your queries are-
1)You must continue taking levipil 1 gm twice a day,regularly and with strict adherence.It is the control of seizures that matter the most.Moreover, as I already said,Levipil is one of the safest antiepileptics with least side effects(except the behaviour changes and personality changes,as discussed above).
2)Even a single missed dose,can result in a seizure.So,strict compliance to therapy is must.
3)Levipil is not an addicting/habit forming drug even in high doses.No habit formation is seen in clinical practice. 2gm/day is not such a high dose.It falls in the optimal dose range.
4)It is not recommended to drive vehicle,till atleast 2 years of seizure free interval is observed.These are clear cut guidelines in the west about it,while the same in XXXXXXX are lacking.Travelling alone is actually to be decided keeping in mind,the frequency of seizures.With current frequency, you can travel alone.However,no clear cut guidelines about it.
5)I don't see any relevance,repeating the brain imaging(CT/MRI) in 6 months unless,a repeat seizure occurs.Otherwise,brain imaging(a CT can do well enough) should be repeated after 2 years of seizure-free interval.
6)Though chronic exposure of high dose radiation increases the chances of brain tumor but 2 times CT is not enough to cause it,nor even 3 times.Actually the risk increase in those,who are getting the CT done every month or every 2-3 months,for some reason or the other.
Hope, I have answered your query.If you have some follow-up queries,I shall be glad to answer else,please close the thread,rate it and write a review.
Dr.Ajay Panwar,
MD,DM(Neurology)
You should not miss antiepileptic dose.Don't drive yourself for now.
Detailed Answer:
Hi XXXXXX,
Thanks for being in follow-up.
You are welcome for the day.
Thanks for appreciating the response.Answers to your queries are-
1)You must continue taking levipil 1 gm twice a day,regularly and with strict adherence.It is the control of seizures that matter the most.Moreover, as I already said,Levipil is one of the safest antiepileptics with least side effects(except the behaviour changes and personality changes,as discussed above).
2)Even a single missed dose,can result in a seizure.So,strict compliance to therapy is must.
3)Levipil is not an addicting/habit forming drug even in high doses.No habit formation is seen in clinical practice. 2gm/day is not such a high dose.It falls in the optimal dose range.
4)It is not recommended to drive vehicle,till atleast 2 years of seizure free interval is observed.These are clear cut guidelines in the west about it,while the same in XXXXXXX are lacking.Travelling alone is actually to be decided keeping in mind,the frequency of seizures.With current frequency, you can travel alone.However,no clear cut guidelines about it.
5)I don't see any relevance,repeating the brain imaging(CT/MRI) in 6 months unless,a repeat seizure occurs.Otherwise,brain imaging(a CT can do well enough) should be repeated after 2 years of seizure-free interval.
6)Though chronic exposure of high dose radiation increases the chances of brain tumor but 2 times CT is not enough to cause it,nor even 3 times.Actually the risk increase in those,who are getting the CT done every month or every 2-3 months,for some reason or the other.
Hope, I have answered your query.If you have some follow-up queries,I shall be glad to answer else,please close the thread,rate it and write a review.
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
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