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Not able to concentrate, complex partial seizures. Taking tegritol, nexito and clobazepam

hi doctor i m navjot kaur and i m 24 years old and i m a veterinarian.i m taking tegritol 600 mg daily twice a day,epilv 250 in morning and 500mg at night, nexito15 mg in morning and clobazepam 5mg twice a day and folic acid also for the last 4 yrs and i want to ask that i m not able to concentrate on anything sply on studies i was to do post graduation but due to this problem i m not doing as doctor has told me not to take stress on my mind. i usually fight wth my parents very much esp wth my mom . i m taking treatment from PGI chandigarh and acco to them i m suffering from complex partial seizures. whenever i miss my med even in morning i used to have an attack like i am unaware of surroundings for just few sec and i dont remember what had happened?i was a very intelligent girl till when i was in 9th class but after that i lost my positions in studies,even i had done my graduation very dificulty pls doctor help me and if want to ask smething more pls do mail me thanx.
Thu, 14 Jun 2012
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Psychiatrist 's  Response
Hi Navjot,
Welcome to Healthcare Magic and thanks for your question...

Epival (Sodium Valproate) and Tegritol (Carbamazepine) are both anti-epileptics and you seem to be on an adequate dosage of both. Clobazam is also an anti-epileptic medication which is usually used as an adjunct to other medication in case of resistant seizures, especially of the complex partial type. It is sometimes used as an anti-anxiety medication also. Nexito (Escitalopram) is an anti-depressant medication.

Now, your difficulty in concentration could be due to different reasons. Recurrent seizures, epsecially if you are skipping medicines often, can be one reason. The anti-epileptic medication, especially as you are on a combination, can sometimes have side effects like concentration and memory difficulties, drowsiness, etc. It is also likely that you may be having some depressive symptoms, which may be the reason you doctor has put you on an anti-depressant. Depression and stress can also be a cause for your difficulty in concentration.

What I would suggest is that you should be absolutely regular on your medication and never skip a dose. Also, discuss with your doctor about your problem, to see if any dose adjustments are required - may be, shifting a majority of your doses to the night. If you are feeling very stressed out or depressed, then it would help to talk to someone, may be a psychiatrist, and to learn relaxation / stress management techniques.

All the best.

- Dr. Jonas Sundarakumar
Consultant Psychiatrist
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Sexologist Dr. Saatiish Jhuntrraa's  Response
Hi Navjot,
Complex Partial Seizures are comparatively resistant to medicines so comparatively higher doses are needed as compared to Gen Tonic Clonic type. kindly get a serum level of carbamazepine done . sample should be given minimum 12 hours after the night dose which may be needed to be hiked. This will help if your problem is a manifestation of abortive seizures. plus carbamazepine is a very good mood stabilizer. memory problem can be due to clobazam so try to taper off and if needed, lamotrigine can be added. Why were you started on nexito? If it was due to anxiety disorder , the dose may be needed to be raised to 20 mg (max permissible)

Take care! and all the best
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