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Does Intake Of Phenytoin Help In Curing Seizures?
Question: i experienced my first seizure a week ago. Do not remember much but was prescribed to take 3 phenytoin sodium extended (Dilantin Extended) 100 mg Capsule each night. I still have not gotten the prescription filled because I wanted to learn what happened and what it does before I start taking it. Now a week has gone by and I am concerned that it might be too late to start or do i need to start now. I want all info i can get on what i am taking and why i need to take it before I do. I also want to know all my options before I start. I have lab reports and treatment reports but i need to unzip them and sort them before I can send them. It will be a few minutes before I can get the card and make a payment also but I will make a payment so please expect one.
Brief Answer:
Do not agree with treatment.
Detailed Answer:
I read your question carefully and I understand your concern.
Personally after reading all the reports I am not sure I agree with the Dilantin prescription.
Phenytoin is an antiepileptic. It is prescribed in epilepsy patients in order to prevent further seizures from happening.
While it is true that epilepsy is a disorder characterized by recurrent seizures, not every person who has a seizure goes on to develop epilepsy. Around 10% of people have a seizure during their lifetime but few of them have epilepsy for which one has to have at least 2 seizures.
That is because seizures can have many causes which are transitory and once removed they do not recur and do not need prevention. Such causes may be electrolyte disturbances, drugs, infections etc.
So it is for that reason that it is not recommended to start treatment for epilepsy with only one single seizure. Exception might be made had imaging test shown some abnormality which will develop and makes you prone to seizures such as a brain tumor, but the CT was normal so there is no reason to think that.
Also the results already show one possible culprit, you test positive for methamphetamine, which does lower seizure threshold, makes you prone to seizures. So that cause should be addressed instead of starting treatment after a single seizure. In my opinion treatment with Phenytoin (or some other antiepileptic should be started only if you have another seizure).
I remain at your disposal for further questions.
Do not agree with treatment.
Detailed Answer:
I read your question carefully and I understand your concern.
Personally after reading all the reports I am not sure I agree with the Dilantin prescription.
Phenytoin is an antiepileptic. It is prescribed in epilepsy patients in order to prevent further seizures from happening.
While it is true that epilepsy is a disorder characterized by recurrent seizures, not every person who has a seizure goes on to develop epilepsy. Around 10% of people have a seizure during their lifetime but few of them have epilepsy for which one has to have at least 2 seizures.
That is because seizures can have many causes which are transitory and once removed they do not recur and do not need prevention. Such causes may be electrolyte disturbances, drugs, infections etc.
So it is for that reason that it is not recommended to start treatment for epilepsy with only one single seizure. Exception might be made had imaging test shown some abnormality which will develop and makes you prone to seizures such as a brain tumor, but the CT was normal so there is no reason to think that.
Also the results already show one possible culprit, you test positive for methamphetamine, which does lower seizure threshold, makes you prone to seizures. So that cause should be addressed instead of starting treatment after a single seizure. In my opinion treatment with Phenytoin (or some other antiepileptic should be started only if you have another seizure).
I remain at your disposal for further questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your answer. It reassured me of my original decision not to start the medication without first understanding my problem. I do understand and realize my problem is most likely related to the drug use. My next concern is how to eliminate the chance of another seizure. From my research I understand that withdrawals from meth is a probable cause of seizures. I was in the process of making a serious life change to eliminate the drug but at the time was not aware of that. So i agree that and believe it was a major cause. Additional information that i have to add now that I did not remember earlier is that recently I had cut down on my intake of meth with the intention of quitting. It is unrealistic for me to quit cold turkey for several reasons but is an important goal for me to accomplish. My health and quality of life are important to me. On the day of the seizure I purposely did not do any meth and had slept most of the day. I had gone to bed early that evening and was told that i had been asleep for 30 minutes when my boyfriend realized i was having the seizure.
Is it correct for me to understand that meth has affected my chemical balance and that maybe I should first correct that chemical balance if possible.
In 2009 I was diagnosed with a low thyroid and prescribed medication. I believed then and still believe now that the meth has affected my thyroid and was able to quit meth previously with the help of thyroid medication. I have not been on thyroid meds consistently since because after running out I have not been able to afford the further testing and Dr.. appt. required without insurance. Later on after I ran out of medication I did find myself back on meth eventually. Since then I have taken meds. What do I need to do to help me both avoid more seizures and successfully get off of meth. Also I have been told not to drive for six months and have a job interview next week. How do I handle the event in my life? Is it ok to drive and does this present any new restrictions to y job abilities. I hav lways been physically strong and I live alone and depend on driving my car but also want to be responsible if I shouldn't drive.
I would like to understand further what my lab results say. Do I have an infection? Am I diabetic or what do I need to address and understand. Additional info on my history. I had endocarditis in 1997 and was diagnosed with a functional heart murmur at age 13. How is my thyroid now and what does the anion gap mean to me?
I also forgot till now the fact of the day I had actually 2 seizures. The 2nd one was at the hospital while in my room. That day I also had constipation and gave myself a couple of enemas. I realise now I was probably dehydrated. My place has a well and the water is not drinkable so I haven't had as much water as I am used to drinking and I recently started drinking coffee for the first time in my life. I never could stand it before but recently started drinking cappuccino at least 2 times a day to help me quit the meth. My research has helped me understand how everything combined probably brought me to the cause. Is everything that I have mentioned made more sense to why I had these seizures or do the tests reflect other problems that I need to be aware of.
Is it correct for me to understand that meth has affected my chemical balance and that maybe I should first correct that chemical balance if possible.
In 2009 I was diagnosed with a low thyroid and prescribed medication. I believed then and still believe now that the meth has affected my thyroid and was able to quit meth previously with the help of thyroid medication. I have not been on thyroid meds consistently since because after running out I have not been able to afford the further testing and Dr.. appt. required without insurance. Later on after I ran out of medication I did find myself back on meth eventually. Since then I have taken meds. What do I need to do to help me both avoid more seizures and successfully get off of meth. Also I have been told not to drive for six months and have a job interview next week. How do I handle the event in my life? Is it ok to drive and does this present any new restrictions to y job abilities. I hav lways been physically strong and I live alone and depend on driving my car but also want to be responsible if I shouldn't drive.
I would like to understand further what my lab results say. Do I have an infection? Am I diabetic or what do I need to address and understand. Additional info on my history. I had endocarditis in 1997 and was diagnosed with a functional heart murmur at age 13. How is my thyroid now and what does the anion gap mean to me?
I also forgot till now the fact of the day I had actually 2 seizures. The 2nd one was at the hospital while in my room. That day I also had constipation and gave myself a couple of enemas. I realise now I was probably dehydrated. My place has a well and the water is not drinkable so I haven't had as much water as I am used to drinking and I recently started drinking coffee for the first time in my life. I never could stand it before but recently started drinking cappuccino at least 2 times a day to help me quit the meth. My research has helped me understand how everything combined probably brought me to the cause. Is everything that I have mentioned made more sense to why I had these seizures or do the tests reflect other problems that I need to be aware of.
Brief Answer:
Read below
Detailed Answer:
As you yourself seem to have understood from your research your seizures are due to not only one single factor but several combined as apart from drugs dehydration is an important factor and caffeine does lower the threshold in predisposed patients as well. So I do not think much further searching must be done as to why these seizures happened.
I am not sure why you think you have infection. You do not mention fever and your white blood cell count was ok (actually even in the WBC was a little high that wouldn't mean infection as it is often high after seizures).
As for diabetes I do not think it is the case either. Yes glucose is higher than norm at 120, but it is a very small increase. And it would be higher only if blood taken when fasting, if it was done the moment of the admission when you might have taken something and also were under considerable stress it is to be called completely normal. If when calm and fasting still only thing I would do is repeat the test in a few months and have a HbA1c test (which shows average in last few months not in moment in time).
What should be done is what you have already done once, get off meth, but very gradually. Whether there is a risk of another seizure, yes there is, it is there for all those in the process of quitting such substances. For that reason should be careful during this process to avoid other influencing factors such as dehydration, lack of sleep, excessive exertion, alcohol etc, try to be on as regular a schedule as possible. Given that you had a 2nd seizure it is understandable now why they started you on treatment. Whether I would now .... if the seizures were close in time, inside a few hours, I still would sway towards not starting it since you've been fine for a week, but it is not a clear cut decision (an EEG might have helped).
As for driving I understand it may have an important impact on your daily life, but I must go with prudence and not do it for 6 months, because no matter how low the risk, it might have catastrophic consequences if you were to have a seizure while driving.
You should start thyroid treatment. It will help you with quitting meth, because the low thyroid function may be related with fatigue, low energy and may be one factor why you craved for amphetamines. As for how to start treatment, the dosage, usually it is started with 50 µg/day and then may be increased if not enough, but some blood tests for thyroid function are advisable first in order to precise the dosage.
I hope to have been of help.
Read below
Detailed Answer:
As you yourself seem to have understood from your research your seizures are due to not only one single factor but several combined as apart from drugs dehydration is an important factor and caffeine does lower the threshold in predisposed patients as well. So I do not think much further searching must be done as to why these seizures happened.
I am not sure why you think you have infection. You do not mention fever and your white blood cell count was ok (actually even in the WBC was a little high that wouldn't mean infection as it is often high after seizures).
As for diabetes I do not think it is the case either. Yes glucose is higher than norm at 120, but it is a very small increase. And it would be higher only if blood taken when fasting, if it was done the moment of the admission when you might have taken something and also were under considerable stress it is to be called completely normal. If when calm and fasting still only thing I would do is repeat the test in a few months and have a HbA1c test (which shows average in last few months not in moment in time).
What should be done is what you have already done once, get off meth, but very gradually. Whether there is a risk of another seizure, yes there is, it is there for all those in the process of quitting such substances. For that reason should be careful during this process to avoid other influencing factors such as dehydration, lack of sleep, excessive exertion, alcohol etc, try to be on as regular a schedule as possible. Given that you had a 2nd seizure it is understandable now why they started you on treatment. Whether I would now .... if the seizures were close in time, inside a few hours, I still would sway towards not starting it since you've been fine for a week, but it is not a clear cut decision (an EEG might have helped).
As for driving I understand it may have an important impact on your daily life, but I must go with prudence and not do it for 6 months, because no matter how low the risk, it might have catastrophic consequences if you were to have a seizure while driving.
You should start thyroid treatment. It will help you with quitting meth, because the low thyroid function may be related with fatigue, low energy and may be one factor why you craved for amphetamines. As for how to start treatment, the dosage, usually it is started with 50 µg/day and then may be increased if not enough, but some blood tests for thyroid function are advisable first in order to precise the dosage.
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your input. One more question. What is anion gap. Should I be concerned with mine?
Brief Answer:
No concern at all.
Detailed Answer:
The anion gap is the difference between measured cations and measured anions in the blood.
It is difficult to explain the significance in simple words but shouldn't think about it. It is measured in critically ill patients to complement other values such as pH, bicarbonates etc (alone with the rest normal doesn't mean much). In you it was taken as patients with seizures may develop transitory acid-base disturbances when having repeated or prolonged seizures.
So at this moment in time it must have certainly returned to normal and shouldn't pay it much thought.
No concern at all.
Detailed Answer:
The anion gap is the difference between measured cations and measured anions in the blood.
It is difficult to explain the significance in simple words but shouldn't think about it. It is measured in critically ill patients to complement other values such as pH, bicarbonates etc (alone with the rest normal doesn't mean much). In you it was taken as patients with seizures may develop transitory acid-base disturbances when having repeated or prolonged seizures.
So at this moment in time it must have certainly returned to normal and shouldn't pay it much thought.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for everything you have provided. I do realize your position and appreciate your input. It will allow me to concentrate on the right things and hopefully overcome this place I have put myself. I plan to use all that you have shared with me and consider this a gift for a chance to do what is the right thing to do for me and everyone involved. I don't hold you accountable for anything but the encouragement I feel. Again thank you.I know whatever happens next is up to only me.
Brief Answer:
Thank you!
Detailed Answer:
Thank you for your kind and appreciative words. I wish you best of luck and good health.
Thank you!
Detailed Answer:
Thank you for your kind and appreciative words. I wish you best of luck and good health.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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