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Question: Post Stroke Patient - Seizure attack
Post Stroke Seizure - Occurred 1 year after the Stroke
Incident report: around 3pm on 11/06/2015, (first incident of type since her Ischemic Stroke - that later on caused infarction in 11/17/2014). The patient started shaking heavily, and lost control of her right body side. She was able to set down in the ground from the chair. Her body muscles got tense, she lost control of limbs, she bite her tongue heavily (to a point it bleed), her eyes rolled up, and there were excessive saliva on her mouth. The incident lasted under 10mins, and within 15mins the patient was taken to the nearest local hospital. Her BP was 110/90 when at the hospital. She was given (diazepam). Patient was able to walk, go to the bathroom, and conscious within 15mins, and was back to her pre-incident conditions after 1 hr.
Patient History:
56 years old, had an ischemic stroke on 11/17/2014, due to blood clog on her heart. Patient has irregular heart rate and Echo-Cardiograph shows thickened left MV to 1.2cm2. Patient also complaint of fibromyalgia pain and takes medication for that regards. The Ischemic Stroke paralyzed her right side of body; she recovered walking back by her, but still suffers from severe Expressive Aphasia. Below is the medication she has been taking for the past year since for her stroke treatment and other conditions.
Medicine she is taking since her May, 2015:
1. Acitrom 2mg (Acenocoumarol) daily depending to her INR/PT - Anti-Coagulant - Current INR at 1.6
2. Atorvastatin 10mg daily – Cholesterol Management
3. Lasilactone 50mg once daily in the morning
4. Betaloc 50/25 (Metoprolol) - Morning/Evening
5. Admenta 10mg (Memantine) – Morning/Evening - Stroke recovery
6. Piracetam 800mg (twice times daily) – to assist with her Stroke recovery
7. Excelon Patch 15mg (Rivastigmine) daily – to assist with her Stroke recovery
8. Pramiplex 0.375mg (one dose at 5pm/daily) – Fibromyalgia pain management
9. Acetaminophen 500mg (when complains of excessive fibromyalgia pain)
Her Health Condition and Improvement prior to the 11/5/15 incident:
1. Her Aphasia (Broca's Aphasia - Expressive) is still very present. There has been little progress (about 40%). She still finds it difficult to say words, read, but understands spoken words and dialog 90% of the time clearly.
2. She can walk on her own.
3. There is good progress in her affected hand - about 70% progress.
4. She complains of pain on her legs and arms at night, but taking Pramiplex .375mg and Acetaminophen 500mg (occasionally) helps with the pain.
5. She does show signs of depression and often cry’s/stresses due to her inability to speak or read.
Is there anything we could do to avoid any future seizures? Is she in risk of Epilepsy? Does she still need to continue with the above medication or she should start with any antiepileptic medicine? This has been her ONLY Seizure
After completing a CT Scan, EEG, Echo Test, the doctors in the local hospital prescribed her these additional medicine:
1- Carbamazepine 200mg
2- Hydergine
3- Folic Acid
4- Pantaprazole
We have NOT started any of the new medicine for her yet, and we are waiting for your kind advice, in order to make sure the medicines do not conflict with each other and that the treatment is suitable for her case. Should she stop any of the medicines that she is currently taking for stroke, and/or to start any of the new medicine that is prescribed for epilepsy?
Post Stroke Seizure - Occurred 1 year after the Stroke
Incident report: around 3pm on 11/06/2015, (first incident of type since her Ischemic Stroke - that later on caused infarction in 11/17/2014). The patient started shaking heavily, and lost control of her right body side. She was able to set down in the ground from the chair. Her body muscles got tense, she lost control of limbs, she bite her tongue heavily (to a point it bleed), her eyes rolled up, and there were excessive saliva on her mouth. The incident lasted under 10mins, and within 15mins the patient was taken to the nearest local hospital. Her BP was 110/90 when at the hospital. She was given (diazepam). Patient was able to walk, go to the bathroom, and conscious within 15mins, and was back to her pre-incident conditions after 1 hr.
Patient History:
56 years old, had an ischemic stroke on 11/17/2014, due to blood clog on her heart. Patient has irregular heart rate and Echo-Cardiograph shows thickened left MV to 1.2cm2. Patient also complaint of fibromyalgia pain and takes medication for that regards. The Ischemic Stroke paralyzed her right side of body; she recovered walking back by her, but still suffers from severe Expressive Aphasia. Below is the medication she has been taking for the past year since for her stroke treatment and other conditions.
Medicine she is taking since her May, 2015:
1. Acitrom 2mg (Acenocoumarol) daily depending to her INR/PT - Anti-Coagulant - Current INR at 1.6
2. Atorvastatin 10mg daily – Cholesterol Management
3. Lasilactone 50mg once daily in the morning
4. Betaloc 50/25 (Metoprolol) - Morning/Evening
5. Admenta 10mg (Memantine) – Morning/Evening - Stroke recovery
6. Piracetam 800mg (twice times daily) – to assist with her Stroke recovery
7. Excelon Patch 15mg (Rivastigmine) daily – to assist with her Stroke recovery
8. Pramiplex 0.375mg (one dose at 5pm/daily) – Fibromyalgia pain management
9. Acetaminophen 500mg (when complains of excessive fibromyalgia pain)
Her Health Condition and Improvement prior to the 11/5/15 incident:
1. Her Aphasia (Broca's Aphasia - Expressive) is still very present. There has been little progress (about 40%). She still finds it difficult to say words, read, but understands spoken words and dialog 90% of the time clearly.
2. She can walk on her own.
3. There is good progress in her affected hand - about 70% progress.
4. She complains of pain on her legs and arms at night, but taking Pramiplex .375mg and Acetaminophen 500mg (occasionally) helps with the pain.
5. She does show signs of depression and often cry’s/stresses due to her inability to speak or read.
Is there anything we could do to avoid any future seizures? Is she in risk of Epilepsy? Does she still need to continue with the above medication or she should start with any antiepileptic medicine? This has been her ONLY Seizure
After completing a CT Scan, EEG, Echo Test, the doctors in the local hospital prescribed her these additional medicine:
1- Carbamazepine 200mg
2- Hydergine
3- Folic Acid
4- Pantaprazole
We have NOT started any of the new medicine for her yet, and we are waiting for your kind advice, in order to make sure the medicines do not conflict with each other and that the treatment is suitable for her case. Should she stop any of the medicines that she is currently taking for stroke, and/or to start any of the new medicine that is prescribed for epilepsy?
Brief Answer:
Stroke treatment should be continued, antiseizure drugs wait.
Detailed Answer:
Hello and thanks for using HCM.
I have read your question and understand your concerns.
General rule about starting an antiseizure drug, or combination is to wait after the first seizure. If seizure repeats, then treatment is needed.
Carbamazepine seems to be a correct choice, since seizures were partial-complex ones.
In my opinion, post stroke and fibromyalgia treatment should continue and if seizures repeat, carbamazepine should be started in addition to actual treatment.
These issues should be discussed with the patient's Neurologyst.
Hope you found the answer helpful.
Let me know if I can assist you further.
Greetings.
Stroke treatment should be continued, antiseizure drugs wait.
Detailed Answer:
Hello and thanks for using HCM.
I have read your question and understand your concerns.
General rule about starting an antiseizure drug, or combination is to wait after the first seizure. If seizure repeats, then treatment is needed.
Carbamazepine seems to be a correct choice, since seizures were partial-complex ones.
In my opinion, post stroke and fibromyalgia treatment should continue and if seizures repeat, carbamazepine should be started in addition to actual treatment.
These issues should be discussed with the patient's Neurologyst.
Hope you found the answer helpful.
Let me know if I can assist you further.
Greetings.
Above answer was peer-reviewed by :
Dr. Prasad
The primary Neurologist has recommended to start Levipil 500 (Levetiracetam) - twice daily. However, Levipil is reported to have side effects of headache and depression. The patient already suffers from post stroke depression symptoms, and often cries due to her inability to speak (expressive aphasia).
Will Levipil be effective for her? Or, Should she hold on to anti-epileptic medication until the next seizure incident? which is better for her case, Levipil or Carbamazepine?
The patient also suffers from ache on her legs and body which keeps her awake during the night... symptoms similar to Fibromyalgia. Patient takes Pramipex 0.375mg, which is somewhat effective, but greater side effects (dizziness, confusion, sleepiness). Can she take Paracetamol daily in addition to Pramipex to manage the pain, on the days that Pramipex is not effective?
Or should she take other medicine for the pain (i.e., pregabalin?). what are the side effects of pregabalin?
best
Will Levipil be effective for her? Or, Should she hold on to anti-epileptic medication until the next seizure incident? which is better for her case, Levipil or Carbamazepine?
The patient also suffers from ache on her legs and body which keeps her awake during the night... symptoms similar to Fibromyalgia. Patient takes Pramipex 0.375mg, which is somewhat effective, but greater side effects (dizziness, confusion, sleepiness). Can she take Paracetamol daily in addition to Pramipex to manage the pain, on the days that Pramipex is not effective?
Or should she take other medicine for the pain (i.e., pregabalin?). what are the side effects of pregabalin?
best
Brief Answer:
Follow up.
Detailed Answer:
Welcome back and thanks for being on follow up.
Levetiracetam is a relatively new generation antiseizure drug with better control on seizures and lesser side effects.
However, all drugs used to control seizures contain potential side effects and mood changes are amongst others.
In the other hand, antiseizure drugs such valproate are used also as mood stabilizers.
Pregabalin is also reported to have potential side effects such dizziness, speech disorders, thinking and gait problems, anxiety, nervousness etc.
We don't know if the patient will experience any side effects or not, and there should be weighted the benefits with the harms that a drug can do.
The patient can use paracetamol in addition to pramipex and if there's sufficient control of symptoms (pain), pregabalin or other drugs aren't necessary.
It is my personal opinion, that antiseizure drugs can be on hold for now.
As always, these issues should be discussed with the treating Doctor.
Hope this helps.
Take care.
Follow up.
Detailed Answer:
Welcome back and thanks for being on follow up.
Levetiracetam is a relatively new generation antiseizure drug with better control on seizures and lesser side effects.
However, all drugs used to control seizures contain potential side effects and mood changes are amongst others.
In the other hand, antiseizure drugs such valproate are used also as mood stabilizers.
Pregabalin is also reported to have potential side effects such dizziness, speech disorders, thinking and gait problems, anxiety, nervousness etc.
We don't know if the patient will experience any side effects or not, and there should be weighted the benefits with the harms that a drug can do.
The patient can use paracetamol in addition to pramipex and if there's sufficient control of symptoms (pain), pregabalin or other drugs aren't necessary.
It is my personal opinion, that antiseizure drugs can be on hold for now.
As always, these issues should be discussed with the treating Doctor.
Hope this helps.
Take care.
Above answer was peer-reviewed by :
Dr. Raju A.T
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