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What Causes Vomiting And Seizure After Discontinuing Eptoin?
Question: Hello Doctor
My Mother aged 74 years had strokes at night last month. She was advised with Eptoin 200mg (at bedtime), Nootropil (thrice a day), Nitrolong(twice a day) and Rejuv Plus (one dose in a day) for 30 days.
After one month, Doctor advised her to stop EPTOIN tablet. Soon after 2 weeks she got U/L seizure again in the night time, after two days of vomiting.
She was diagnosed with low sodium level and after consultation of Neurologist, it was mentioned that stopping Eptoin is also one of the main reasons for getting seizure second time.
After discharge, she was advised to continue EPTOIN for one more month and during followup, EPTOIN is now stopped and the following tablets are advised to be continued:
MEROCAL D3 1-0-0
AD GRIL A 0-1-0
LEVIPRIL 500 mg 0-0-1
ROZIMER 10 mg 0-0-1
Glucerna SR Powder Low calorie nutrition for people with Diabetes
Please advise whether stopping EPTOIN will again cause the risk or using Levipil is good enough. Moreover, what are the precautions to be taken and whether any symptoms to be looked for to prevent her from getting seizures again. Both the times, it came in night and hence how to identify for symptoms and take preventive action. Please advise. Reports are attached for your reference.
My Mother aged 74 years had strokes at night last month. She was advised with Eptoin 200mg (at bedtime), Nootropil (thrice a day), Nitrolong(twice a day) and Rejuv Plus (one dose in a day) for 30 days.
After one month, Doctor advised her to stop EPTOIN tablet. Soon after 2 weeks she got U/L seizure again in the night time, after two days of vomiting.
She was diagnosed with low sodium level and after consultation of Neurologist, it was mentioned that stopping Eptoin is also one of the main reasons for getting seizure second time.
After discharge, she was advised to continue EPTOIN for one more month and during followup, EPTOIN is now stopped and the following tablets are advised to be continued:
MEROCAL D3 1-0-0
AD GRIL A 0-1-0
LEVIPRIL 500 mg 0-0-1
ROZIMER 10 mg 0-0-1
Glucerna SR Powder Low calorie nutrition for people with Diabetes
Please advise whether stopping EPTOIN will again cause the risk or using Levipil is good enough. Moreover, what are the precautions to be taken and whether any symptoms to be looked for to prevent her from getting seizures again. Both the times, it came in night and hence how to identify for symptoms and take preventive action. Please advise. Reports are attached for your reference.
Brief Answer:
Levipil is an excellent drug.For now,continue with Levipil.
Detailed Answer:
Hi XXXX
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.
If your mother would have presented to me as an outpatient,I would have advised that Levipil is an excellent antiepileptic drug and safe in old age.For now,as the epitoin has been stopped,she should continue with Levipil only and be observant if any further seizures occur.If seizure occurs again in future,levipil dose may be increased and other drugs may be added upon.Levipil alone should be good enough for now.When epitoin has been substituted with levipil,it should not increase seizure risk.
Precautions to be taken to prevent seizures-
1)Strict adherence to medicines.Missing a single dose may cause seizures.
2)Adequate sleep as lack of sleep precipitates seizures.
3)Stress free enviornment.
If a seizure occurs,make him lie in a left lateral position to prevent lung aspiration and insert a mouth gag to prevent tongue bite.
There are no specific symptoms as such which can help to prevent the seizures.Just a few seconds before a seizure,patient may have premonitory symptoms like palpitations,paleness of face and strange sensations in the body.But,at that time nothing can be done to prevent the seizure as these symptoms are just the part of seizure.No other symptoms tell in advance that a seizure is going to come.
What is to be done to prevent the seizures,then?-
1)Don't miss a dose.
2)Adequate sleep.Minimal stress.
3)Other illness like fever,may precipitate seizures.So,treat them in time.
Hope I have answered your query.If you have some follow up questions,I shall be glad to answer else,please close the thread-rate it and write a review as your rating will be of help to me.
Dr.Ajay Panwar,
MD,DM(Neurology)
Levipil is an excellent drug.For now,continue with Levipil.
Detailed Answer:
Hi XXXX
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.
If your mother would have presented to me as an outpatient,I would have advised that Levipil is an excellent antiepileptic drug and safe in old age.For now,as the epitoin has been stopped,she should continue with Levipil only and be observant if any further seizures occur.If seizure occurs again in future,levipil dose may be increased and other drugs may be added upon.Levipil alone should be good enough for now.When epitoin has been substituted with levipil,it should not increase seizure risk.
Precautions to be taken to prevent seizures-
1)Strict adherence to medicines.Missing a single dose may cause seizures.
2)Adequate sleep as lack of sleep precipitates seizures.
3)Stress free enviornment.
If a seizure occurs,make him lie in a left lateral position to prevent lung aspiration and insert a mouth gag to prevent tongue bite.
There are no specific symptoms as such which can help to prevent the seizures.Just a few seconds before a seizure,patient may have premonitory symptoms like palpitations,paleness of face and strange sensations in the body.But,at that time nothing can be done to prevent the seizure as these symptoms are just the part of seizure.No other symptoms tell in advance that a seizure is going to come.
What is to be done to prevent the seizures,then?-
1)Don't miss a dose.
2)Adequate sleep.Minimal stress.
3)Other illness like fever,may precipitate seizures.So,treat them in time.
Hope I have answered your query.If you have some follow up questions,I shall be glad to answer else,please close the thread-rate it and write a review as your rating will be of help to me.
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Dear Dr. XXXXXXX Panwar
Thanks for your quick response and I am very much satisfied with the details provided.
I forgot to mention in my earlier email couple of items, which I would like to share it now. Attached the MRI for your reference.
a. When she got strokes for the first time in XXXXXXX 2015, the MRI of the Brain showed “Recent Right Parietal and Corona Radiata Infarcts.
There is evidence of Left Maxillary Sinusitis.”
Doctor has informed us that there are some blood clots identified in couple of places and treatment was given and she was discharged after a week from Hospital. Attaching the Scan report and Discharge summary for your reference.
1.Will the blood clot gets cleared with few doses of injection? How do we know that the clot is cleared?
She was complaining of right eye twitching from beginning of XXXXXXX 2015. Is this due to blood clot identified earlier? Even now, from yesterday she again complains of eye twitching. Is this due to the medicines or the earlier problem of blood clot?
2. When she got seizure for the second time in Mar 2015, it was identified that the sodium level was very low.
Now that summer has started, bit worried on the sodium level. Will there be any symptoms to look for if the sodium level gets low.
Before hospitalising my mother, she was having continuous vomiting for around 2 days and felt very weak.
To summarize my questions:
a. How do we know the blood clot is cleared and she is normal? Any symptoms to be looked for?
b. What are the symptoms when sodium level gets low in her body?
Thanks
XXXX
Thanks for your quick response and I am very much satisfied with the details provided.
I forgot to mention in my earlier email couple of items, which I would like to share it now. Attached the MRI for your reference.
a. When she got strokes for the first time in XXXXXXX 2015, the MRI of the Brain showed “Recent Right Parietal and Corona Radiata Infarcts.
There is evidence of Left Maxillary Sinusitis.”
Doctor has informed us that there are some blood clots identified in couple of places and treatment was given and she was discharged after a week from Hospital. Attaching the Scan report and Discharge summary for your reference.
1.Will the blood clot gets cleared with few doses of injection? How do we know that the clot is cleared?
She was complaining of right eye twitching from beginning of XXXXXXX 2015. Is this due to blood clot identified earlier? Even now, from yesterday she again complains of eye twitching. Is this due to the medicines or the earlier problem of blood clot?
2. When she got seizure for the second time in Mar 2015, it was identified that the sodium level was very low.
Now that summer has started, bit worried on the sodium level. Will there be any symptoms to look for if the sodium level gets low.
Before hospitalising my mother, she was having continuous vomiting for around 2 days and felt very weak.
To summarize my questions:
a. How do we know the blood clot is cleared and she is normal? Any symptoms to be looked for?
b. What are the symptoms when sodium level gets low in her body?
Thanks
XXXX
Brief Answer:
Follow up MRI.Impairment of consciousness.
Detailed Answer:
Hi XXXX,
Thanks for being in follow-up and appreciating.
I have been through further medical details provided by you and here follow the answers to your query:
1)No symptoms can tell clearing of clots.It is follow up MRI that has to be done a few months later,which will be deciding on this.Only MRI will tell the status of clots,not the patient.
2)Low sodium levels(hyponatremia) most commonly presents with impaired consciousness(or drowsiness) or seizures.
Hope I have answered your query.If you have some follow up questions,I shall be glad to answer else,please close the thread-rate it and write a review as your rating will be of help to me.
Dr.Ajay Panwar,
MD,DM(Neurology)
Follow up MRI.Impairment of consciousness.
Detailed Answer:
Hi XXXX,
Thanks for being in follow-up and appreciating.
I have been through further medical details provided by you and here follow the answers to your query:
1)No symptoms can tell clearing of clots.It is follow up MRI that has to be done a few months later,which will be deciding on this.Only MRI will tell the status of clots,not the patient.
2)Low sodium levels(hyponatremia) most commonly presents with impaired consciousness(or drowsiness) or seizures.
Hope I have answered your query.If you have some follow up questions,I shall be glad to answer else,please close the thread-rate it and write a review as your rating will be of help to me.
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Answered by
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