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Suggest treatment for seizures, lupus and pituitary adenoma

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Posted on Mon, 24 Aug 2015
Question: Hello Doctor, my name is XXXX. I've been having seizures for the last 8 months. I have had a positive diagnosis of Lupus sle for 20 yes now. I do not drink alcohol or take illegal drugs. I also was diagnosed with a pituitary adenoma. I take ms contin 30x 2 ,gabapentin 800x 3 ,clonopin1 mg prn ,trazadone for sleep. Im afraid of a ct scan for what it may be. I am 50 years old . my email address is YYYY@YYYY
doctor
Answered by Dr. Olsi Taka (1 hour later)
Brief Answer:
Imaging is essential

Detailed Answer:
I read your question carefully and I am sorry about the symptoms you are experiencing.

The fact that you suffer from lupus is a very important piece of information. Lupus can affect the nervous systemnin many different ways causing various manifestations including seizures.
That can be through damage of small blood vessels in a diffuse manner or damage to bigger vessels through inflammation, called vasculitis. There is also the possibility of ischemic stroke, blockage of a blood vessel which can be due to heart damage or due to increased coagulation by certain antibodies.

So it is really important you have brain imaging, even though you are afraid. According to the finding and thr damage mechanism management could vary.

Also the fact you have lupus doesn't make you immune to other conditions. There can be something not related to lupus like say meningeoma a slow growing benign brain tumor which can manifest only with seizures, easily treated through surgery. That is why imaging is always indicated in seizures in an adult. The preferred exam is MRI with contrast, not the CT which you mention.

As for the treatment, you seem to be under two drugs for seizures gabapentin and clonazepam (clonopin). Without knowing your type of seizure, EEG report and other drugs you have taken before can't evaluate that, not common first line therapy though, usually other drugs are tried first (valproic acid, levetiracetam etc).

I remain at your disposal for further questions.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Olsi Taka (2 hours later)
Thank you so very much Dr Taka,
I forgot to tell you about my many dvt s. I've had 11. Worst was Cr 1996. 6 months gestation with 2 very large dvt in my illiac. Very painful....and left leg 4dvt . 3 leg, 1 left lunglung. Yadda yadda.
I occasionally smoke hydroponic p. Not wanting to admit, yet it helps. Please, if you will send to my correctcorrect E-mail @ XXXX@ YYYY@YYYY .
Again, thank you doctor,for taking time for my issues
doctor
Answered by Dr. Olsi Taka (11 minutes later)
Brief Answer:
Read below

Detailed Answer:
Thank you for that additional info.

That confirms that you must have a coagulation disorder predisposing you for stroke. I wonder if you have been tested for antiphospholipid antibody syndrome, very common in patients with lupus which can manifest with repeated stroke which in turn can be the cause for your seizures.
If that is the case you should be treated with anticoagulant treatment (either warfarin or the newer oral anticoagulants) or there is the risk for recurrent stroke in the future which can be even more serious, prevention is the key.
Rea
As for the email, I am assuming you have put a wrong email address in your info. Problem is I can not change that, only a moderator or administrator can, I do not have such an option in my interface.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Olsi Taka (24 minutes later)
Dr. Being in pain mgmt , they will find pot in my system. I am still in pain and do not want to be black balled from this program. Anyway, I will rate you as perfect. Your time and knowledge was impeccable. Respectly, XXXX
doctor
Answered by Dr. Olsi Taka (8 hours later)
Brief Answer:
Read below

Detailed Answer:
I understand your concern, but the fact that one has pot in the system doesn't mean he can be denied medical assistance for other issues, as I said seizures in a high risk stroke person is a serious issue. Anyway if you really fear thar you can try to stop pot for the time for it to be undetectable, such times vary among individuals and frequencynof use but generally 10 days are enough.

Thank you for your appreciative words. I hope you will get better soon.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Olsi Taka

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Practicing since :2004

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Suggest treatment for seizures, lupus and pituitary adenoma

Brief Answer: Imaging is essential Detailed Answer: I read your question carefully and I am sorry about the symptoms you are experiencing. The fact that you suffer from lupus is a very important piece of information. Lupus can affect the nervous systemnin many different ways causing various manifestations including seizures. That can be through damage of small blood vessels in a diffuse manner or damage to bigger vessels through inflammation, called vasculitis. There is also the possibility of ischemic stroke, blockage of a blood vessel which can be due to heart damage or due to increased coagulation by certain antibodies. So it is really important you have brain imaging, even though you are afraid. According to the finding and thr damage mechanism management could vary. Also the fact you have lupus doesn't make you immune to other conditions. There can be something not related to lupus like say meningeoma a slow growing benign brain tumor which can manifest only with seizures, easily treated through surgery. That is why imaging is always indicated in seizures in an adult. The preferred exam is MRI with contrast, not the CT which you mention. As for the treatment, you seem to be under two drugs for seizures gabapentin and clonazepam (clonopin). Without knowing your type of seizure, EEG report and other drugs you have taken before can't evaluate that, not common first line therapy though, usually other drugs are tried first (valproic acid, levetiracetam etc). I remain at your disposal for further questions.