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madp · 06-04-2006, 05:14 PM

Head injuries cause what is known as "partial" seizures, and they can grow into what is called a "secondarily generalized" seizure (partial = petit mal; generalized = grand mal). However, if you control the partial seizure, you prevent the secondarily generalized seizure from occuring. I would bet the farm that the "episodes" you witnessed with your husband were types of partial seizures.

If I were in your husbands shoes, Lamictal would be my first choice for treating the depression. Lamictal was introduced as a treatment for partial seizures, and has recently been recognized as an effective treatment for bipolar depression. While it doesn't have an FDA indication for unipolar depression, there is alot of anecdotal evidence that it is effective in these cases as well. Thus, the drug can kill two birds with one stone: help prevent seizures, and help treat the depression. For me, it would be a no-brainer.

A few of caviats:

First, seizure doses of Lamictal tend to be larger than depression doses (e.g., 400mg/day vs. 200mg/day), so there is no guarantee that a depression-sized dose will effectively control seizures. Dilantin (phenytoin) would be the last drug I would be on for seizure control over the long term because, while very effective, it potentially causes too many complications. There are at least 6 drugs I would want to try *before* settling for Dilantin, but neurologists have been using it for so many years that they are quite comfortable with and competent at managing Dilantin patients.

Second, due to the risk of a very serious rash known as Stevens-Johnson syndrome, Lamictal has to be started very slowly. However, all psychs and neurologists are aware of the risk, and will titrate the drug very slowly (which *greatly* reduces the risk). Stevens-Johnson occurs *very* rarely when the drug is used properly, and the rare cases I have seen have been caused by a general practicioner who was not adequately experienced with the drug.

Third, if a patient starts Lamictal and it either doesn't work for them, or they have side effects that they can't tolerate, it must be discontinued very slowly (i.e., reducing the dose a little at a time) due to the risk of inducing a seizure if it is discontinued abruptly.

Finally, I would not allow a general practicioner to treat my depression given the history of seizures. I would seek out a competent psychiatrist, and I would lay out all my concerns on the table. I would also lay out my expectations that he share his thought process with me, and be completely up front about risks associated with my treatment given the experience I had with my general practicioner.

Again, I am not giving you or your husband specific treatment recommendations. I am just sharing with you what I would do if I were the patient. Take it for what it's worth!

*EDIT:* I missed the part of your post where you said your husband is now on Lamictal. I think that most neuro's and psych's would agree that this would be the first med they would try in your husband's case, so it sounds like the problem is taken care of!

06-04-2006, 05:14 PM	#34 (permalink)
madp Insane Location: New Orleans/Chicago	Head injuries cause what is known as "partial" seizures, and they can grow into what is called a "secondarily generalized" seizure (partial = petit mal; generalized = grand mal). However, if you control the partial seizure, you prevent the secondarily generalized seizure from occuring. I would bet the farm that the "episodes" you witnessed with your husband were types of partial seizures. If I were in your husbands shoes, Lamictal would be my first choice for treating the depression. Lamictal was introduced as a treatment for partial seizures, and has recently been recognized as an effective treatment for bipolar depression. While it doesn't have an FDA indication for unipolar depression, there is alot of anecdotal evidence that it is effective in these cases as well. Thus, the drug can kill two birds with one stone: help prevent seizures, and help treat the depression. For me, it would be a no-brainer. A few of caviats: First, seizure doses of Lamictal tend to be larger than depression doses (e.g., 400mg/day vs. 200mg/day), so there is no guarantee that a depression-sized dose will effectively control seizures. Dilantin (phenytoin) would be the last drug I would be on for seizure control over the long term because, while very effective, it potentially causes too many complications. There are at least 6 drugs I would want to try before settling for Dilantin, but neurologists have been using it for so many years that they are quite comfortable with and competent at managing Dilantin patients. Second, due to the risk of a very serious rash known as Stevens-Johnson syndrome, Lamictal has to be started very slowly. However, all psychs and neurologists are aware of the risk, and will titrate the drug very slowly (which greatly reduces the risk). Stevens-Johnson occurs very rarely when the drug is used properly, and the rare cases I have seen have been caused by a general practicioner who was not adequately experienced with the drug. Third, if a patient starts Lamictal and it either doesn't work for them, or they have side effects that they can't tolerate, it must be discontinued very slowly (i.e., reducing the dose a little at a time) due to the risk of inducing a seizure if it is discontinued abruptly. Finally, I would not allow a general practicioner to treat my depression given the history of seizures. I would seek out a competent psychiatrist, and I would lay out all my concerns on the table. I would also lay out my expectations that he share his thought process with me, and be completely up front about risks associated with my treatment given the experience I had with my general practicioner. Again, I am not giving you or your husband specific treatment recommendations. I am just sharing with you what I would do if I were the patient. Take it for what it's worth! EDIT: I missed the part of your post where you said your husband is now on Lamictal. I think that most neuro's and psych's would agree that this would be the first med they would try in your husband's case, so it sounds like the problem is taken care of! __________________ why are you wearing that stupid man suit? Last edited by madp; 06-04-2006 at 06:03 PM..