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Dr. Andrew Rynne

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What causes memory loss and sudden seizures while on Keppra?

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Dr. Olsi Taka

Neurologist

Practicing since :2004

Answered : 3425 Questions

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Posted on Sun, 12 Mar 2017 in Headache and Migraines
Question: My husband is taking keppra for seizures which started after he received a pacemaker On 10/17/11. It was reinstalled on 11/4/11 because he pulled the out right after surgery. He didn't want to wear the sling was provided with, he didn't need it etc. In 2012 he started having seizures and each new seizures caused more memory loss. I requested something to stop the seizures and memory loss. The neurologist we went to see was the nurse practioner who assumed he had alzheimers because I said memory loss. He had an MRI and EEG before he got his pacemaker and was a clean XXXXXXX of health. So we didn't get anything for seizures but we got a prescription for arricept. I did not give it to him because it was not what I requested. He started at 250 mg of keppra twice a day. The when we saw the neurologist, he doubled the dosage to 500mg twice a day and my husband had a seizure, We got the dosage back down to 500 a day. Which worked fine he quit taking it unknown to me in Feb and March 2015. Dec. 2014 he had 2 detached retinas that were repaired but damage more than minimum because as usual he was insisted he could see but he really couldn't. On March 2, 2015, he had 5 seizures because I later found the keppra the floor. He refused to swallow any pills because he didn't like the color one of the eye pressure pills he had to take to help his eyes. He took the green pill just fine, the blue one was OK, but wild at the thought of a orange and white (if I remember correctly). He has not swallowed any pill since. That includes vitamins and supplements that he has taken for years. I was told at the hospital that I could crush the keppra to get it into him. Since that time I have had to cancel any Dr. appointments because he had refused. And after reading some of the side effects tonight about changes in behavior shivering (which he blames on his being cold), his left arm shakes so hard at times that the lamp on the table rattles. My question is "do these side effects start after a number of years of taking keppra instead of right away like I been reading on line?" Don't tell us to ask his neurologist because we don't have one. I made arrangements to go new one and he told her in no uncertain terms what he thought of her - sight unseen. She refused to refill his prescription because he hadn't been to their office in over 2 years so our local has taken over getting the prescription filled.
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Answered by Dr. Olsi Taka 3 hours later
Brief Answer:
No, they do not start years later.

Detailed Answer:
I read your question carefully and I am sorry about the difficult situation you are in. It is really tough when you try to care about someone refuses help.

Regarding your specific questions on whether behavior side effects of Keppra could be seen years late I am afraid the answer is no, they are seen in the first weeks/months of therapy. Also they are reversible once Keppra is stopped so that can't be the cause.

I remain at your disposal for other questions.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Olsi Taka 17 hours later
Thank you for your information.
I think I may have misled you unintentionally. He is still taking his 500 mg a day. But the only way I can get the keppra in him is by crushing it each morning and use it as a topping on his toast and topping that with honey. The only good thing about his limited vision is that he doesn't know it is his keppra he is eating. The toast also has oatmeal and other grains on the top that are white. The last time he was weighed in 2016 his weight was up to about 107. In 2015 he was down to 90 lbs.

If I am reading you right, if he quit the keppra his side effects would go away. But I don't want to take away his keppra and have to deal with grand mal seizures. So has the keppra run its course with him and it is time to switch medicine. Today he decided to quit eating because he is going to be dead soon anyway. He doesn't care about his teeth or jaws that are hurting. It is getting harder to even make a bowl of soup that he will eat that won't eat his jaws when trying to eat it. He broke off 4 of his real teeth in 2016 because he didn't want to glue in his partials and when he gets mad his partials do not stay in place in his mouth. In the middle of 2015 after the reattachment of his retina, his potassium was low. He was prescribed potassium chloride until the opthamologist took it away since it was working the eye pressure prescription. I am giving him B12 with folic acid crushed in his oatmeal everyday. That was recommended by a Dr. in 2008. In other words all I can do is for him be in enough pain and have to call the ambulance to get him inside the hospital for some blood tests and whatever.
doctor
Answered by Dr. Olsi Taka 11 hours later
Brief Answer:
Read below

Detailed Answer:
Thank you for clearing that up, I thought he wasn't under Keppra now.

If he is still having seizures though that doesn't mean that Keppra has failed. That dosage he is taking is very low, dosage starts usually from 1g daily and can go to 2500 mg a day. 500 mg is the initial starting dose but it is not therapeutic, it is increased to at least twice daily.

I understand the difficulties for giving it to him, but there's no way around that, even other medication for seizures work similarly, started at a low dose and then increased, usually more than once daily. There is an extended release form though for Keppra, called Keppra XR, that can be given 1000 mg once daily.

Let me know if I can further assist you.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Olsi Taka 1 hour later
Thank you for your information.

He hasn't had a seizure since March 2, 2015 and I don't want him to have another one. I am more concerned about the side effects such as the anger episodes, garbled speech, crazy sleep patterns, shivering, shaking so hard he can hardly hang onto a spoon or fork to eat. He has a big appetite and we eat at least 4 times a day. Some times we will eat a meal, in 5 minutes he wants to when we are going to eat because he hasn't had a thing to eat all day. He gets really angry and throws things when I don't get something out for him to eat right away. He doesn't remember when he has eaten sometimes. So I will fix some food, maybe just a piece of toast to get him to calm down. He has basically whipped most health issues out of his mind that have happened since May 2011. He remembers his clients prior to 2006 before he retired but doesn't remember doing tax returns for 40 years. I have always said he "had selective amnesia".

I can live with that but the out of control anger, physical actions such as the shivering and his shaking so hard the table shakes. That is what I am most concerned about because he is a danger to himself and whoever gets in the way at the time. So I am trying to figure out what could be causing them and keppra is the only prescription drug he is taking now and has been since the middle of 2016.

Thank you again. I appreciate your opinion and insight into his problem.
doctor
Answered by Dr. Olsi Taka 9 hours later
Brief Answer:
Read below

Detailed Answer:
As I said I doubt Keppra is the cause of his behavior changes, especially at that low dose. However if he has been seizure free for 2 years at that dosage one might consider the possibility of going of Keppra altogether, when one is seizure free for 2 years it is an option which must be considered in all patients. Can be brought to 250mg for a couple of weeks and then interrupted.

If no improvement is seen it is a little hard to advise what to do next since he doesn't cooperate. It is unclear when he's had the MRI, if before these behavior changes then I would advise another brain imaging exam (a CT since with a pacemaker) and some blood tests for metabolic changes, vitamin B12 deficiency, thyroid hormone. Afterwards perhaps an antidepressant may be considered, but again these are all considerations which are not of much value if he doesn't accept any help.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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