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Having seizures. Diagnosed with bipolar disorder. Having migraines and dizziness. Have blurred vision. What to do?

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Yes hi, I am a 32 yo white female and about 2 years ago I started having seizures. They would happen at work, etc but only like once a month. I have also been diagnosed with bipolar disorder for years, so my physician, neurologist, and psychiatrist blamed the once a month seizures on that. then the seizures became more often and more often and over the past 2 years I now have seizures pretty much on a daily basis. I have migraines and dizziness. I cannot walk straight and I have very blurred vision, and I also have restless leg syndrome and insomnia and consistently hear things. Is this neurological or am I a crazy person?
Posted Sun, 4 Aug 2013 in Bipolar Disorder
Answered by Dr. Anjana Rao Kavoor 53 minutes later
Thanks for writing in.

I have read your question in detail and observe that you first had seizure a two years back. Earlier you have been diagnosed to be suffering from Bipolar disorder for years. Hence your seizures were thought to be a result of your bipolar problem. Now, the seizures have become almost a daily occurrence and this is your present concern.

You also complain about your dizziness, migraines, inability to walk straight, blurred vision and restless leg syndrome.

You are having some sort of problem which may be neurological and psychiatric in nature and could be due to the bipolar problem and also the treatment received for it over the years.

I would like to know in detail about the onset of you bipolar problem, the medications taken for so many years and their dosages. I would also like to know if you had any CT scan or MRI scan of your brain and reports. Nay EEG investigation reports also would be helpful

I would also like to know about your previous consultations with psychiatrists and therapy sessions undergone in detail. Please also share any important life events in the recent past that may have led to the increase in seizures.

All information provided with you will remain confidential.

Waiting to hear from you with an update.

Dr A. Rao Kavoor
Above answer was peer-reviewed by
Follow-up: Having seizures. Diagnosed with bipolar disorder. Having migraines and dizziness. Have blurred vision. What to do? 4 hours later
Hello again doctor. It does not seem that you received my last post so I will do my best to write it again. I was first diagnosed with depression at age 15. The dr. talked my parents into a light anti-depressant and things became way worse. This left a bad taste in my parents mouth about psychiatry and meds. Soon after I was hospitalized for a suicide attempt and I was forced to see a doctor but the medication did not work so I didn’t take it, so for many years I self medicated, which never makes things better. I was finally diagnosed with bipolar disorder around the age of 24. I was put on lamictal, Geodon, Ativan, and there may have been a few others. It was good for a few years and then the meds stopped working, so the dr. started experimenting with new drugs and doubling the doses of current drugs and I didn’t last long on this at all. I had a nervous break with psychosis and basically no clue where I was and was taken to a psych ward, where they stated I was being overdosed everyday and could have died. I had to stay there for awhile to detox and I know one drug that I was put on was invega because I hated it. So when I got out and got a new dr. he put me on some new meds.By this time I was much more aware of what I put into my body and even though some of the things has side effects of seizures, I was not to concerned because I had never had one. Lamictal, Geodon, and Effexor xr were meds that stayed pretty consistant in my life. When this doctor moved away, I got a new doctor, who is my current dr. and has been for years. First he tried to tell me I had ADHD and prescribed Vyvanse. I did not believe that I has ADHD, because by now I had two masters degrees in forensic science and pharmaceuticals. I never took the Vyvanse. My careers didn’t last long, because as I did my interships, the tremors started, aka t.d. I resigned my position, and applied for disability and they gave it to me no questions asked. Then 9 months ago my condition just got worse and worse. I’ve lowered medication doses with my physicians help, but the symptoms get worse and worse. I’ve lost my job, my home, I have to stay with my parents who make sure that I don’t have seizures and regulate medication which is so embarrassing. I only leave the house to go to dr.’s appointments, hospitals, and very few other places. I have a brand new car that I can’t even drive. My seizures have been witnessed by family, friends, doctors, nurses, and some will still try to to put me on things such as Seroquel or trazadone, and if I remember correctly they both cause seizures, and I’ve already gone off of Geodon because of its side effects.
Any suggestions that you may have, recommendations, and I know you are in a tight spot not being my doctor in person and all and I believe my doctors are trying but are not finding the solution. I am searching myself for answers but I am not a doctor, and am right now not well or in a good frame of mind. I don’t wish for sympathy because I am in fact lucky, God watches over me and keeps me alive and I have family to care for me but on the other side, my dreams and everything that I have worked so hard for, has been taken away. I would love to have my life back- but not at just any cost. I’ll suffer before someone else, but if you have any suggestions, or even a dr. you could recommend me to, I would greatly appreciate it. Oh- I have had a CT and EEG- both normal.
Thank You, XXXXX
Answered by Dr. Anjana Rao Kavoor 11 hours later

Thanks for writing back with the elaborate history,

From your history I gather, you developed depression at the age of 15 and were treated with antidepressants which worsened with drugs. This was followed by suicide attempt and hospitalization, self-medicated yourself thereafter till the age of 24 when you were diagnosed with bipolar disorder. Maintained well on lamotrigine (?dosage), ziprasidone and lorazepam. This worked for few years but there was a breakthrough psychotic episode while on medication then hospitalized. Then onward doctors have been trying to optimize your dosage and switch to other drugs because of poor response. Paliperidone (invega) was used in the hospital that did not suit you. You have been taking lamotrigine, ziprasidone and venlafaxine consistently. You then developed tardive dyskinesia and then seizures for which you had to go off the antipsychotic ziprasidone and are still having symptoms of hearing things.

I would try and give you some of the options that you have for your problems. T.D is a commonly encountered side effect with antipsychotic drugs, which is comparatively less with newer drugs (like ziprasidone) but nonetheless still a problem. If there are any anticholinergic drugs like trihexyphenidyl in your regimen that you may not have mentioned then it is advisable to stop it. Dose reduction is tried and agents that are less likely to cause TD are used like clozapine, quetiapine and olanzapine. There are additional agents like tetrabenazine that can be tried. Benzodiapines like clonazepam and diazepam are used as well, but mostly intermittently to avoid tolerance. Few have been shown to benefit from vitamin E as well, but this is not yet conclusive. Rarely some patients have shown improvement on amino acids, botulinum toxin, pyridoxine, melatonin and a few others. These have been tried in patients and have benefitted few patients. Some of this treatment, we have limitations trying it on you because of the risk of seizures (like clozapine) while benzodiazepines (diazepam) in your case will benefit both TD and seizures.

Coming to seizures, antipsychotics can reduce the threshold of seizures in patients and hence induce them. It is not a very commonly seen side effect but is encountered. There are a few antipsychotics that have been found to have a low seizure inducing potential like molindone, haloperidol, fluphenazine, pimozide and trifluoperazine. But these are older antipsychotics and carry a risk of TD. An option for this is adding an anticonvulsant in your regimen to control the seizures. You are already on one- lamotrigine, but since it is not controlling your seizures it would be worth optimizing its dosage or trying others like sodium valproate. This is assuming that the seizures are ONLY caused by the antipsychotic drugs. There may be various causes of seizures. It may be worth investigating it in detail once to rule out all other possible causes. MRI brain is a very useful tool for this. The other option one has is electroconvulsive therapy which has shown very good results in many and is explored when medications pose such side effects and make it difficult to use. It may carry some stigma with it from what we hear or see in the media but it does wonders to many patients. There are newer options like rTMS or transcranial magnetic stimulation that do not require any anesthesia and are completely painless.

Venlafaxine also rarely causes both TD and seizures; we also need to make sure that this drug is not the culprit.

Regarding the initial part where you said psychiatry and medicines left a bad taste in your parents’ mouth, I would like to say that depression in young can take various courses and the treatment usually varies with each. Sometimes what looks like a depressive disorder turns out to be bipolar disorder and it may get difficult for the psychiatrist to tell beforehand what it may end up being. There are subtle signs but none of them are confirmatory. And in such cases a mood stabilizer (like lamotrigine in your case) helps more than an antidepressant. Nevertheless, now what we need to do is find a suitable combination of drugs for you and that takes some trial by the doctors. Since these drugs take time to act, as hard as it may seem, I’m sure patience will yield to be beneficial for you. What you have been going through is understandably hard and you have been very brave. It is also commendable that you have such great insight into your illness, not all patients we encounter have this much information about their illness. Keep up the good job and I am sure things will work out well soon.
Discuss this with your psychiatrist and explore the options that you have.

I hope this answers your question,
Write back in case of any doubts,
Dr. A. Rao. Kavoor.

Above answer was peer-reviewed by
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