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Treatment for SEIZURE DISORDER with sleeping difficulty.

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I have a seizure disorder. Have taken phenobarbital most of my life but has stopped working. Have tried several new meds. Currently on dilantin which caused severe insomnia. Doctor prescribed lamictal but stay on dilantin until up to a therapeutic level on lamitctal. Also taking low dose of pheno to help with sleep. Still having trouble with sleep and now have a voracious appetite. Help! I am so miserable.

I started on the dilantin on May 21 but didn't have problems until I tapered off and stopped phenobarbital.  I am now taking 400 mg of dilantin a day.  I started the lamictal two weeks ago at 50 mg and am now up to 100 mg.  As soon as I started lamictal, I developed a major increase in appetite which is not typical.  I'm taking 64 mg of pheno a day for sleep.  Doc wants me to work up to 500 mg of lamictal then taper off dilantin.   I started taking dilantin in the morning .  It doesnt make me tired.  I'm still not sleeping much.  I wake up and can't go back to sleep.  I have terrible itchy feeling arms and legs.  I usually take ibuprofen, or aspirin for that .  Some nights, like tonight it doesn't help at all.  I am so miserable.  Please help!  I am a 47 year old female.

 

Category: Neurologist, Medical

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Dr. Sudhir Kumar
Category: Pediatric Neurologist
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 30 Doctors Online

Expert:  Dr. Sudhir Kumar
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Hello.

Thank you for posting your query on DoctorSpring.com.

I have noted the medical details and current medications. I agree with the management approach.

For sleep problem, you may take STILNOX (zolpidem sustained release tablets) at night. It can be taken on a daily basis and there are no long term side effects such as dependence or day time sleepiness.

I hope this helps. Feel free to ask queries.

Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology),
Senior Consultant Neurologist.


Patient replied :

So are these typical side effects? I am really not sure if I can live with them. Can I go off the dilantin to see if that makes things better?


Expert:  Dr. Sudhir Kumar
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Thank you for getting back.
Yes, these side effects are usual and fairly common. You can get the serum dilantin level tested in the blood. If the level is high, you may reduce the dose of dilantin. Otherwise, if the side effects are unmanageable with normal levels of dilantin in blood test, you may come off it, and try other anti-epileptic drugs.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology),
Senior Consultant Neurologist.


Patient replied :

Thanks for your help. What schedule can I use to go off the Dilantin as soon as possible?


Expert:  Dr. Sudhir Kumar
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Thank you for getting back.

You can reduce the dose of dilantin by 25% of total dose every week, so you can come off it in 3-4 weeks.
For example, if you were taking 100 mg, reducing 25% of 100 mg, the dose will be 75 mg for the 1st week and so on.

Let me know if I can assist you any further.

Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology), Senior Consultant Neurologist.

Dr. Sudhir Kumar
Category: Pediatric Neurologist
Experience: 
Senior Residency, Fellowship: DM, Neurology, CMC, Vellore, 2001
Junior Residency: MD, Internal Medicine, CMC, Vellore, 1998
Medical School: MBBS, Christian Medical College, Vellore, 1995
Dr. Sudhir Kumar and 4 other Medical Specialists are ready to help you

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