Dualtherapy Keppra and Lamict

[Anonite]

Hi,

Wondering if I can get some advice so my son was put on Keppra back in March unfortunately it did not work for him so they have introduced Lamictal. He is currently on 1500mg of Keppra twice a day and will be on 100mg of Lamictal twice a day maintenance dose. The Neurologist did not mention when we should or even if the Keppra will be reduced. Speaking to the epilepsy nurse she said if nothing happens this usually will happen in around 12 weeks. I’m nearly afraid to suggest weaning him off the Keppra when the time comes in case it cases a seizure but then again I don’t want him loaded up on medication unnecessarily. Is there anyone on here where Keppra didn’t work and made the change to Lamictal? Any advice would be greatly appreciated. Thanks.

[mxcosta]

Hi Ruth, good morning.

I was on Keppra for almost 5 years (1500mg/day), and it did reduce my "absence crisis", but even then, i'd some of them regularly (1 each 15 days, so on).

On June this year, after a greaaaaaat loss of my mineral bone density, i've asked my neurologist and him said we could change for Lamictal.

I've been since then, reducing Keppra and increasing Lamictal.

3 weeks ago, i've dropped Keppra completely and had only 1 absence crisis since then. Yesterday i've gone to the neurologist again, and he told me to see the next 2 weeks how my brain will be, but my wife said that Lamotrigine is working better than Levetiracetam for me.

Now i'm on 300mg Lamictal (100mg morning / 200 mg night) + 100mg Fenobarbital (night)

The doctor want to remove completely the Fenobarbital as well, and said that eventually will increase the Lamotrigine to 400mg (200 + 200).

Let's see how it'll be the next 2 weeks

Ah, and since Levetiracetam alone was not working, i've been put on 1800mg Oxcarbazepine, and even then, didn't was so good as now with Lamotrigine

Hope it helps

[Anonite in reply to mxcosta]

Thank you,

It definitely helps great to hear that you are doing better on the Lamictal hopefully my son will do as well on it also. You sound like you have a lot of experience with different meds have you found that you have any side effects with the Lamictal titration or even when you were weaning off the Keppra? Good luck with everything and thanks again for the reply☺️

[mxcosta in reply to Anonite]

Hi again Ruth.

Yeah, i've been using meds for my epilepsy since 2017, and i've already used soooo many....

With these drugs, i've had two side effects:

1) "exanthema" (rash) on my hands: i don't know if you're familiar with the name, but this made my hands feels like it was in "fresh meat".... if i don't use a medicinal cream on my hands, it gets really red, with some dots, and it hurts a lot when it get serious.... i don't like using this cream called - it's called "Esperson N" - sdrugs.com/?c=drug&s=espers... - , mainly because it consists on Desoximetasone, and from what i know, using corticoids on a long term is not good, but.... i've decided to see which med for my brain would do better, and then i would look for my hands, but 5 years since the beggining of using meds, and still haven't found one that had made me free from the absence crisis till now... Lamotrigine + Fenobarbital seems to be having the best results so far.... and the second side effect is......

2) Reduce of bone density: this is a greaaaaaat problem that NONE of my neurologists (I've been on many of them already), had never told me to be careful about it.... and i've just discovered that because i stopped using my meds, since they were not working plenty (still having like 1 crisis per week, so so), and the side effect number 1, that was very painful to deal without that "Esperson N".... so i stopped using my meds, reducing it gradually, because my mom also has epilepsy and i've seen her having a seizure so i know that you can't stop using them abruptally, and so i was stopping using them step by step... i was on Levetiracetam 1500mg and Oxcarbazepine 1800mg.... and then after one month without using them, i'd a seizure that cause my shoulder be broken, even witm me not having fall in the ground.... i was sleeping and in my bed, just with the movements of the body caused by the seizure, i'd to go to a surgery on my right shoulder.... just after that, going on orthopedists, they explained me that ALMOST ALL meds to treat epilepsy cause them.... even that not being said in the package insert in the meds, i've done a great research on that and i've discovered that.... =(

I'm 39 years old, and my exam of the bones had a big "OSTEOPOROSIS" written on it.... =/ .... and my orthopedist told me that this was not possible having only 39 years old.... he told me that for men, they only begin to do bone tests after the age of 70..... so i asked why i'd osteoporosis, and the answer was on the package insert of Levetiracetam.... but what made me more sad is that only one of them, called ETIRA (here in Brazil), had written that on the leaflet... other brands of Levetiracetam had not that write on it (Keppra, Spark, Tam, etc - these are names sold here in Brazil).... anyway, just this one called "Etira" that had written on it that it's a COMMON SIDE EFFECT....

So, i don't know the age of your son, but i believe that God has put me here to told you about it, so you can check the bone density of your child from 6 to 6 months, if he continue using these meds....

May God bless you and your family.... I'll be praying for you and your son, that God's will be made on your life.... some things we do not understand.... but i can assure you that it's all on God plans , even being hard to accept, but His misteries are beyond our imagination...

So, keep the faith, and believe that Jesus have all under control and love each one of us ^_^ <3