Adverse effects from taking prednisilone and anticholinergic drugs?

[humlies]

Hallo wonderful people, I recently had an episode of transient global amnesia, which with hindsight was embarrassing since I was giving a talk at the time! None of the possible reasons seemed to apply to me, so I investigated possible drug related causes. I found a possible link to Spiriva, which I inhale for COPD, also found a possible link to adverse reactions when taking prednisilone and anticholinergics. I was told after the event that I did not need a brain scan, but ever since (about 3 weeks ago) I have felt dizzy, nauseous, and colossally tired. I am in the process of reducing to 2 1/2 mg of pred, and really do not know whether I am suffering because of this or because of the TGA. I really need help!! Thank you all for the support that you give to me and many others.

[PMRpro Ambassador]

I have had 3 TGAs since I have had PMR - the first was before I was diagnosed but it also coincided with a big flare in symptoms. That was in the UK and they made a right meal of diagnosing it - the A&E consultant got it right straight off, the medical consultant on take that night decided it was drinking and the stroke lead that it might be epilepsy and she stopped me driving which was a right performance getting my surrendered licence back and DVLA told me she shouldn't have done so until waiting a month to see what happened. It was textbook GCA too. The others were here in Italy - they got it right.

There was no apparent cause of any of mine except the third when they realised I was having quite severe episodes of bradycardia (slow heart rate) as part of my known paroxysmal atrial fibrillation. It might have been I was on a bit too much medication for that and I had one of the BP meds stopped. But I was also fitted with a pacemaker - no more bradycardic events - and after that the cardiologist said she thought the TGAs were related to the arrythmia and it was unlikely I will have any more.

Given your current pred dose - I would suspect adrenal insufficiency is causing the symptoms you describe. The effects of a TGA do hang around for a while and the actual event is quite stressful so you would normally have a boost of cortisol to help your body get over it all. I wouldn't be reducing the dose at all at this level and I might even go up a bit - sort of in line with Sick Day Rules.

But don't expect to be totally over the TGA already. Though I think my husband worried far more about it/them than I did. We were told in the UK that they were rare and it wouldn't happen again - I soon knew better as I heard of people who had had a couple and I was also surprised how many people I knew who had had one. But it hasn't happened since the pacemaker - my cardiologist was right I think - and my older daughter who is a nurse also said she thought it was the a/f.

[humlies in reply to PMRpro]

My goodness, PMR pro, what a useful reply! Thank you so much . I have learned more from you than from anyone at A&E - nice though they were. (especially the paramedics who stayed with me during the 4 hours I was waiting outside A&E - I was so much better off than being in the dire waiting room). It is reassuring to think that it takes some time to recover from TGA; I was told there would be no after effects. I have upped the pred to 3mg to see if that makes a difference. (Incidentally did you have a brain scan after either TGA?)

[PMRpro Ambassador in reply to humlies]

The advantage I found each time was I got through A&E and knew nothing about it!!!!

What sort of brain scan? As far as I know (I wasn't "there" to remember) I had a CT immediately each time - they have to rule out stroke. I had an EEG after the first, some weeks later. I don't THINK I had an MRI but I might have done!

[humlies in reply to PMRpro]

Yes, I should have said CT scan/MRI. I had neither (I was perfectly compos mentis by this time!) though I did have an EEG.

[PMRpro Ambassador in reply to humlies]

Mine lasted about 5 or 6 hours I think - time to do quite a bit. And after the first they were really covering the stroke bit - echocardiogram and carotid scan and something else before he would discharge me. He thought it would take a few days - OH called in favours from colleagues and it was a single sweep, one after the other

[Rosina1871]

I had a TGA a few years ago and felt rough for about three weeks. Headaches, tiredness and generally feeling unwell

[humlies in reply to Rosina1871]

Thank you Rosina. I am mystified as to why I was told there would be no after effects!!

[PMRpro Ambassador in reply to humlies]

Possibly because none of them had ever had one and didn't see the patients after they were discharged - at which point you haven't noticed any deficits.

[humlies in reply to PMRpro]

Very true!

[jarn]

Had no idea that TGA was rather common. I had one 35yrs ago where I lost about 12hours of memory. Diagnosis, after CT Scan, was that it was brought on by "Stress". There was no follow-up so can't add anything else. No symptoms since then. Appreciate reading your cases.

[humlies in reply to jarn]

Yes mine too was put down to stress - a useful thing when nothing ese seems to fit! I am still investigating a possible link between TGA and anticholinergic drugs.