Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
What Causes No Control Of Nerves And Muscles In Eyes?
Question: Hi,
I take Lexapro 5 mg, Klonopin 4 mg, Solian 100 mg aand Keppra 1000mg for anxiety. In low dose, from 100 mg to 200 mg, Solian has a well known dopaminergic effect and i had had serious troubles with this. I had had an "ocd like symptom" but is just "like", not exactly ocd: my eyes move quickly, i feel i don't have control of nervbes and muscles of the eyes, i have troubles with their movement and eyes focuses on poen windows of cars (something strange): When my eyes see those windows, my eyes cannot recognize the dephtness of the image, the foreground and the rest, and my mind cannot do any association and look normally to this image.
The problem is being corrected with Keppra and Klonopin (so, antiepileptics) and i have nothing abnormal in electroencephalogram, but i would like to know if a dopaminergic effect of a med can create this strange sensation of "flat image", problems to understand the relief of yhe image, all this corrected strangely by antiepileptics..
Thanks beforehand, XXXXXXX
I take Lexapro 5 mg, Klonopin 4 mg, Solian 100 mg aand Keppra 1000mg for anxiety. In low dose, from 100 mg to 200 mg, Solian has a well known dopaminergic effect and i had had serious troubles with this. I had had an "ocd like symptom" but is just "like", not exactly ocd: my eyes move quickly, i feel i don't have control of nervbes and muscles of the eyes, i have troubles with their movement and eyes focuses on poen windows of cars (something strange): When my eyes see those windows, my eyes cannot recognize the dephtness of the image, the foreground and the rest, and my mind cannot do any association and look normally to this image.
The problem is being corrected with Keppra and Klonopin (so, antiepileptics) and i have nothing abnormal in electroencephalogram, but i would like to know if a dopaminergic effect of a med can create this strange sensation of "flat image", problems to understand the relief of yhe image, all this corrected strangely by antiepileptics..
Thanks beforehand, XXXXXXX
Brief Answer:
It can, but partial seizure can as well.
Detailed Answer:
Hello! I read your query as well as some past queries of yours, thank you for choosing this site over and over for your health related questions.
As you yourself say it is hard to classify this type of phenomena you describe.
One probable explanation is what you suggest, it being a dopaminergic related manifestation, visual hallucinations, abnormal vision can be a known dopaminergic side effect and this might be a type of visual hallucination.
Another explanation could be it being a type of partial seizure. Apart from the popularly known generalized seizures, convulsions, there are also partial, otherwise called focal seizures, resulting from abnormal discharges in a limited brain area. Manifestations can vary according to the area. If the area is in the temporal lobe of the brain, it can cause abnormal sensations, including visual ones like you describe it. Keppra and Klonopin being antiepileptics can be effective. I understand electroencephalogram (EEG) resulted normal, but an EEG doesn't exclude the diagnosis. Unless the patient is having a seizure during the exam itself, an EEG is abnormal only in about 50% of the cases, so it being normal doesn't exclude the seizure.
I remain at your disposal for other questions
It can, but partial seizure can as well.
Detailed Answer:
Hello! I read your query as well as some past queries of yours, thank you for choosing this site over and over for your health related questions.
As you yourself say it is hard to classify this type of phenomena you describe.
One probable explanation is what you suggest, it being a dopaminergic related manifestation, visual hallucinations, abnormal vision can be a known dopaminergic side effect and this might be a type of visual hallucination.
Another explanation could be it being a type of partial seizure. Apart from the popularly known generalized seizures, convulsions, there are also partial, otherwise called focal seizures, resulting from abnormal discharges in a limited brain area. Manifestations can vary according to the area. If the area is in the temporal lobe of the brain, it can cause abnormal sensations, including visual ones like you describe it. Keppra and Klonopin being antiepileptics can be effective. I understand electroencephalogram (EEG) resulted normal, but an EEG doesn't exclude the diagnosis. Unless the patient is having a seizure during the exam itself, an EEG is abnormal only in about 50% of the cases, so it being normal doesn't exclude the seizure.
I remain at your disposal for other questions
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. Taka,
Thank you very much for your answer. As far as i understand, dopaminergic activity can make abnormal vision (i can say i don't have hallucinations, but i understand it can be a type of hallucination).
When i was taking Klonopin with Lamictal (Lamotrigine), i had the same problem (it was in 2009). The problem changed with Klonopin + Keppra ( i mean with both of them, while it was not working with Klonopin +Lamictal/Lamotrigine). As far as i know, Keppra action has to do with calcium channels and dopamine too, because of exocytosis (trough calcium). Can this information confirm some kind of abnormal dopaminergic activity caused by Solian (amisulpride) at low dosage? Can this have some relation with some kind of abnormal discharge due to dopamine (maybe in temporal lobe)?
I am sorry because in my first question i forgot this information and i think it's important (i can say also that i don't have this visual problem with Solian 400 mg, just Solian 200 mg or 100 mg).
Best regards, XXXXXXX
Thank you very much for your answer. As far as i understand, dopaminergic activity can make abnormal vision (i can say i don't have hallucinations, but i understand it can be a type of hallucination).
When i was taking Klonopin with Lamictal (Lamotrigine), i had the same problem (it was in 2009). The problem changed with Klonopin + Keppra ( i mean with both of them, while it was not working with Klonopin +Lamictal/Lamotrigine). As far as i know, Keppra action has to do with calcium channels and dopamine too, because of exocytosis (trough calcium). Can this information confirm some kind of abnormal dopaminergic activity caused by Solian (amisulpride) at low dosage? Can this have some relation with some kind of abnormal discharge due to dopamine (maybe in temporal lobe)?
I am sorry because in my first question i forgot this information and i think it's important (i can say also that i don't have this visual problem with Solian 400 mg, just Solian 200 mg or 100 mg).
Best regards, XXXXXXX
Brief Answer:
Read below
Detailed Answer:
Thank you for that additional information.
Regarding the first point. Kepra's, mechanism of action is not well known. It is true that it involves presynaptic calcium channels, but not much beyond that is known and I wouldn't dare make other assumptions involving dopaminergic action. Perhaps you might have encountered some hypothesis on the net, but I repeat that the mechanism is not fully known. The comparison with Lamotrigin doesn't mean much, antiepileptic drugs have different mechanisms of action, it is not uncommon at all that a switch from one drug to another with different mechanism may result effective. So keppra being more effective than lamotrigine in itself wouldn't exclude the possibility of a partial seizure.
On the other hand, you make a very good suggestion regarding amisulpride dosage, that information may be very significant. If you have consistently noticed that the episodes are not present at higher dose, but only at lower ones, that goes in favor of the dopaminergic hypothesis. As to the why you seem to be well informed, it's the dopa antagonist effect coming into action.
Kind regards,
Dr Olsi
Read below
Detailed Answer:
Thank you for that additional information.
Regarding the first point. Kepra's, mechanism of action is not well known. It is true that it involves presynaptic calcium channels, but not much beyond that is known and I wouldn't dare make other assumptions involving dopaminergic action. Perhaps you might have encountered some hypothesis on the net, but I repeat that the mechanism is not fully known. The comparison with Lamotrigin doesn't mean much, antiepileptic drugs have different mechanisms of action, it is not uncommon at all that a switch from one drug to another with different mechanism may result effective. So keppra being more effective than lamotrigine in itself wouldn't exclude the possibility of a partial seizure.
On the other hand, you make a very good suggestion regarding amisulpride dosage, that information may be very significant. If you have consistently noticed that the episodes are not present at higher dose, but only at lower ones, that goes in favor of the dopaminergic hypothesis. As to the why you seem to be well informed, it's the dopa antagonist effect coming into action.
Kind regards,
Dr Olsi
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. Taka,
Thanks a lot for your information, so i have a last question: this dopa antagonist effect coming into action can provoke a partial seizure and maybe one in temporal lobe? It's the last thing i don't understand very well.
Thank you for your patience and best regards, XXXXXXX
Thanks a lot for your information, so i have a last question: this dopa antagonist effect coming into action can provoke a partial seizure and maybe one in temporal lobe? It's the last thing i don't understand very well.
Thank you for your patience and best regards, XXXXXXX
Brief Answer:
Read below
Detailed Answer:
It's a very good question. Yes, all antipsychotic group of drugs have a small potential for lowering seizure threshold. So many drugs do for that matter, Lexapro as well, since it's about neurotransmitters with all these drugs, any neurotransmitter level change can alter cell membrane electric potential.
However it is a question of generalized seizure, not a focal one limited in only one tiny brain area, so do not think it's your case (and you say the episodes disappear when raising the dosage anyway, so no need to think that).
I hope to have been of help.
Read below
Detailed Answer:
It's a very good question. Yes, all antipsychotic group of drugs have a small potential for lowering seizure threshold. So many drugs do for that matter, Lexapro as well, since it's about neurotransmitters with all these drugs, any neurotransmitter level change can alter cell membrane electric potential.
However it is a question of generalized seizure, not a focal one limited in only one tiny brain area, so do not think it's your case (and you say the episodes disappear when raising the dosage anyway, so no need to think that).
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. Taka,
Excuse me, but it's still not clear. At low dose Solian 100-300 mg (amisulpride) provokes dopaminergic activity (enhances dopamine release), acting like an antidepressant (used then by some doctors for negative symptoms of schizophrenia), and it's in this way different from other antipsychotics, not lowering seizure threshold, i guess, but on the contrary!. This dopaminergic activity can be provoking seizures in temporal lobe (or some kind of generalized seizure) since this one is associated with the kind of symptoms i have? When changing to another antipsychotic (for example Serlect-sertindole), which not enhances dopamine release, the same symptom disappears (and i take at the same time Lexapro). My case could be a generalized seizure or a focal one because of my kind of symptom? It's not clear in the last answer, sorry.
Regards, XXXXXXX
Excuse me, but it's still not clear. At low dose Solian 100-300 mg (amisulpride) provokes dopaminergic activity (enhances dopamine release), acting like an antidepressant (used then by some doctors for negative symptoms of schizophrenia), and it's in this way different from other antipsychotics, not lowering seizure threshold, i guess, but on the contrary!. This dopaminergic activity can be provoking seizures in temporal lobe (or some kind of generalized seizure) since this one is associated with the kind of symptoms i have? When changing to another antipsychotic (for example Serlect-sertindole), which not enhances dopamine release, the same symptom disappears (and i take at the same time Lexapro). My case could be a generalized seizure or a focal one because of my kind of symptom? It's not clear in the last answer, sorry.
Regards, XXXXXXX
Brief Answer:
Read below
Detailed Answer:
Hello again! I'll try to recap the seizure part.
First, if your episodes were seizures they would be a focal seizure, not a generalized one. In a generalized seizure there is loss of consciousness. A focal seizure, by focal means related to only a limited area, not spreading to the rest of the brain, consciousness is preserved.
Now the low dose scenario of Solian. There is increased dopamine action. This does not influence seizures, does not incite them. So if yours were seizures Solian at this dose would have no influence on them.
High dose scenario of Solian. It blocks dopamine receptors, hence the term dopa antagonist as dopamine action is blocked. This is what happens with all other antipsychotics. This has been associated with a slightly higher frequency of seizures.
So when comparing the low and high dose in terms of influence on seizures, higher doses might cause seizures or make them more frequent if already present before (in a small % of patients, in many has no influence at all), low dose has no influence. That is why the fact they disappear at high dose makes them being seizures less likely, would be either the same or worsen.
Even in the scenario those were temporal lobe seizures, they would not be due to the drugs (because drugs cause generalized not focal seizures), they would have a separate origin triggering them in the temporal lobe.
I hope to have been more understandable this time around.
Read below
Detailed Answer:
Hello again! I'll try to recap the seizure part.
First, if your episodes were seizures they would be a focal seizure, not a generalized one. In a generalized seizure there is loss of consciousness. A focal seizure, by focal means related to only a limited area, not spreading to the rest of the brain, consciousness is preserved.
Now the low dose scenario of Solian. There is increased dopamine action. This does not influence seizures, does not incite them. So if yours were seizures Solian at this dose would have no influence on them.
High dose scenario of Solian. It blocks dopamine receptors, hence the term dopa antagonist as dopamine action is blocked. This is what happens with all other antipsychotics. This has been associated with a slightly higher frequency of seizures.
So when comparing the low and high dose in terms of influence on seizures, higher doses might cause seizures or make them more frequent if already present before (in a small % of patients, in many has no influence at all), low dose has no influence. That is why the fact they disappear at high dose makes them being seizures less likely, would be either the same or worsen.
Even in the scenario those were temporal lobe seizures, they would not be due to the drugs (because drugs cause generalized not focal seizures), they would have a separate origin triggering them in the temporal lobe.
I hope to have been more understandable this time around.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dr. Olsi,
Thank you for your information about generalized seizures.
You told me 17 hours ago this:
"On the other hand, you make a very good suggestion regarding amisulpride dosage, that information may be very significant. If you have consistently noticed that the episodes are not present at higher dose, but only at lower ones, that goes in favor of the dopaminergic hypothesis. As to the why you seem to be well informed, it's the dopa antagonist effect coming into action".
And you told me 18 hours ago:
"One probable explanation is what you suggest, it being a dopaminergic related manifestation, visual hallucinations, abnormal vision can be a known dopaminergic side effect and this might be a type of visual hallucination."
Now you write that dopamine action of Solian at low dose does not incite seizures. I understand. I don't have seizures, not even from temporal lobe, as far as i know. Finally: what i have then is a "dopaminergic effect" but without seizures, according to what you wrote, am I right?
In this case (a dopaminergic effect), the problem is being corrected because Klonopin acts against catecholamines (as i was told here) and there is also something in Keppra helping to stop dopaminergic effect (because there must be an explanation for Keppra acting well instead of Lamotrigine).
Since the beginning and as you wrote, i am not talking about seizures but about a problem with Solian at dose 100-200 mg (the problem is worse at 200 mg, so there is a problem with Solian), so now i understand that i have a "dopaminergic effect" with some kind of "visual hallucination". Please if possible just confirm me this, even if i don't know which part of the brain under dopaminergic effect can cause this kind of abnormality (if you have information, welcome!). XXXXXXX
Thank you for your information about generalized seizures.
You told me 17 hours ago this:
"On the other hand, you make a very good suggestion regarding amisulpride dosage, that information may be very significant. If you have consistently noticed that the episodes are not present at higher dose, but only at lower ones, that goes in favor of the dopaminergic hypothesis. As to the why you seem to be well informed, it's the dopa antagonist effect coming into action".
And you told me 18 hours ago:
"One probable explanation is what you suggest, it being a dopaminergic related manifestation, visual hallucinations, abnormal vision can be a known dopaminergic side effect and this might be a type of visual hallucination."
Now you write that dopamine action of Solian at low dose does not incite seizures. I understand. I don't have seizures, not even from temporal lobe, as far as i know. Finally: what i have then is a "dopaminergic effect" but without seizures, according to what you wrote, am I right?
In this case (a dopaminergic effect), the problem is being corrected because Klonopin acts against catecholamines (as i was told here) and there is also something in Keppra helping to stop dopaminergic effect (because there must be an explanation for Keppra acting well instead of Lamotrigine).
Since the beginning and as you wrote, i am not talking about seizures but about a problem with Solian at dose 100-200 mg (the problem is worse at 200 mg, so there is a problem with Solian), so now i understand that i have a "dopaminergic effect" with some kind of "visual hallucination". Please if possible just confirm me this, even if i don't know which part of the brain under dopaminergic effect can cause this kind of abnormality (if you have information, welcome!). XXXXXXX
Brief Answer:
Read below
Detailed Answer:
At the beginning in my first answer I gave two separate possibilities which both could cause those visual phenomena of yours. One was the possibility suggested by you, the other a seizure originating in the temporal lobe of the brain. Both could manifest that way, so I couldn't say whether one or the other. That is medicine, at times there is only one clear diagnosis, other times there are several possibilities. I know that you weren't talking about seizures, it was my suggestion as a doctor based on your symptom, I suppose that is why you come here, to seek our expertise and be presented with alternative opinions, not for us to say you're right straightaway.
Afterwards when you brought the additional information on the fact the issue appeared only at low doses of Solian and disappeared with high doses, I swayed towards the possibility suggested by you (because the dose increase brushed away the dopaminergic effect on one hand and on the other hand if a seizure shouldn't improve.
So I now am more inclined towards the dopaminergic effect possibility which you believe as well. I still can not exclude the seizure possibility with certainty (there is no definitive test for epilepsy unfortunately, electroencephalography can miss it), but I think it less likely.
As to why Keppra is beneficial, that I can not explain actually. That is because as I mentioned before Keppra's mechanism of action is not completely known. It is known the calcium channel part as to what it does to dopamine levels/receptors is not elucidated by science. There are studies on that regard, suggestions of use in Parkinson levodopa complications, but nothing clear yet.
Coming to your last point, how does increased dopaminergic action affect visual sensations. Dopamine is a neurotransmitter in several brain pathways. Among these are the pathways in the mesolimbic system. Alterations in this system can be related with distorted sensations, perceptions like the visual perception in your case. So that would be a possible mechanism in your case.
Naturally neurotransmitters are very complex and hold many unknown sides to science, our knowledge of their intricate circuits in the brain is still evolving. The future will certainly propose more mechanisms of action of both natural pathways and man made drugs.
Read below
Detailed Answer:
At the beginning in my first answer I gave two separate possibilities which both could cause those visual phenomena of yours. One was the possibility suggested by you, the other a seizure originating in the temporal lobe of the brain. Both could manifest that way, so I couldn't say whether one or the other. That is medicine, at times there is only one clear diagnosis, other times there are several possibilities. I know that you weren't talking about seizures, it was my suggestion as a doctor based on your symptom, I suppose that is why you come here, to seek our expertise and be presented with alternative opinions, not for us to say you're right straightaway.
Afterwards when you brought the additional information on the fact the issue appeared only at low doses of Solian and disappeared with high doses, I swayed towards the possibility suggested by you (because the dose increase brushed away the dopaminergic effect on one hand and on the other hand if a seizure shouldn't improve.
So I now am more inclined towards the dopaminergic effect possibility which you believe as well. I still can not exclude the seizure possibility with certainty (there is no definitive test for epilepsy unfortunately, electroencephalography can miss it), but I think it less likely.
As to why Keppra is beneficial, that I can not explain actually. That is because as I mentioned before Keppra's mechanism of action is not completely known. It is known the calcium channel part as to what it does to dopamine levels/receptors is not elucidated by science. There are studies on that regard, suggestions of use in Parkinson levodopa complications, but nothing clear yet.
Coming to your last point, how does increased dopaminergic action affect visual sensations. Dopamine is a neurotransmitter in several brain pathways. Among these are the pathways in the mesolimbic system. Alterations in this system can be related with distorted sensations, perceptions like the visual perception in your case. So that would be a possible mechanism in your case.
Naturally neurotransmitters are very complex and hold many unknown sides to science, our knowledge of their intricate circuits in the brain is still evolving. The future will certainly propose more mechanisms of action of both natural pathways and man made drugs.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
