Ask the Expert, Dr. Alan Ettinger, Medications and Side Effects

Ask the Expert with Alan Ettinger, MD – Medication and Side Effects

EttingerDr. Alan Ettinger, Chief of the Division of EEG and Epilepsy at the North Shore-LIJ Comprehensive Epilepsy Centers, continues the Ask the Expert series by answering questions you have about medications and its side effects. To see past episodes of this series, click here.

The following questions were answered by Dr. Ettinger for Episode 2, "Medications and Side Effects":



I have episodes where I experience déjà vu. Ex. the other day I was walking down the road and it happened. It builds up slowly my and heart starts to pace. I feel faintness, like if you were to fall. This builds up for about 15 seconds then goes the déjà vu. Everything seems like I'd been there before-the people passing me the cars etc... This has happened for about 10 years. I'm 24 now, I have been to doctors and they put a heart monitor on me for 24 hours but nothing showed up. I've been looking on the internet at epilepsy and déjà vu experiences. This only happens around 4 times a year and afterwards I feel a bit tired and I think my memory is affected. Is this anything to worry about?

Déjà vu episodes are common in certain forms of epilepsy such as those with seizures arising from the temporal lobe. Sometimes, extended EEG monitoring is the best way to capture evidence of epilepsy. I would consider getting an evaluation at a specialty epilepsy center. The key issue here is whether the déjà vu is isolated or is in fact associated with some degree of decreased responsiveness. The other issue would be to determine why you have developed this.


I have had "E" most my life & I feel that there are other things that are more important than what happens after we have a seizure, ex. like needing to sleep. How do you get others to understand that this is how your body feels best and that doing things afterwards is not the best? My family does not understand when I try to explain this (I think my kids do 14 and 16) but my husband does not. He expects me to do things after a short nap. I get massive headaches afterwards.    

I would suggest that you ask your doctor to sit down both you and your husband to provide education about all of these issues.  Your local epilepsy foundation may also be able to provide additional information and may even suggest support groups or discussion groups to further clarify this information.  Symptoms of fatigue or headaches are classic post-seizure symptoms.


I'm currently taking Dilantin 100mg (extended phenytoin sodium) 3 capsules a day.  It seems as if I'm loosing my eye sight, and some facial staining. Is that normal?    

Antiepileptic drugs such as Dilantin can sometimes cause blurry vision or even frank double-vision, particularly at higher doses.  This effect is reversible however with lowering or eliminating the medication.  I would recommend having an ophthalmologist perform a thorough evaluation of your visual symptoms before attributing this to Dilantin.  Dilantin can cause some cosmetic side effects although I am unclear about the nature of the “staining” or its relationship to Dilantin.  Again, a specialist such as a dermatologist can be helpful. There are many alternatives to Dilantin should you and your doctor feel you are incurring side effects.


I've been on Dilantin on and off for about 10 years and it has worked well for seizure control. Recently, however, I've started to feel depressed, especially since my hair has been falling out for about a year. I don't know if my mood and hair loss are connected to hormonal changes but that's my suspicion. (I'm 38) I'm considering asking to be placed on Yasmin or another pill high in estrogen. Could that help with these issues?   (I was diagnosed with an AVM when I was 22 that left me paralyzed for a while and has resulted in occasional seizures).    

Dilantin has been reported in an earlier literature to be associated with depression but epilepsy itself or other factors may be playing a role.  I would be very careful with the use of agents that have high estrogen content as estrogen has been cited to lower the seizure threshold.  I would recommend that you get assistance from both a mental health professional as well as a dermatologist.  The hair-loss may be due to one of many other potential causes.


I have been on anti seizure medication for four years now and the longer I am on them (I am on Zonegran) the more problems I am having with depression and mood swings.  How do you try to combat this when going off the meds is not an option?     

While your doctor may feel you need to remain on antiepileptic medications, if there is a relationship between the Zonegran and depression, there may be other antiepileptic drugs to choose from that will not carry this side effect for you.  Please discuss these options with your doctor.  You may also want to get a mental health professional involved in your care to address your depression symptoms which may not be so simply explained as a medication side effect.


My epilepsy began at the age of 14 and was under control straight away with Epilm. At the age of 18, it came back with a vengeance.  I ended up having 11 a day and no medication would work. I have been on Keppra, topiramate, phenytoin, Phenobarbital, epilm and others. At one point, taking 3 different medications at the same time. I have had vns therapy and it is now under control. I still, however, have problems with anxiety and depressive episodes even though I am nearly off all my medication. Is this due to my frontal lobe epilepsy, or losing my independence as a teenager? Please help! I need some answers.   

The epilepsy itself and the psychosocial complications are just two of the potential causes.  I am pleased to hear that your seizures are under control and now it is important for you to attend to your emotional needs. I would strongly recommend a thorough evaluation by a mental health professional.  Anxiety and depression associated with epilepsy are eminently treatable.


I'm a 29 year old female with 2 children.  I was diagnosed with epilepsy 8 years ago.  Since then my life changed for the worst. I suffer from migraines and insomnia as well. All the drugs that I have tried have not worked. I went for a neck manipulation in November 2006 and this has helped. I am running out of ideas and the situation seems bad. I also suffer from really terrible chest pains and numbness (right side). I’ve had an MRI and it looked fine.   

There is an elevated rate of headaches including migraines among individuals suffering from epilepsy and vice versa.  I am personally not a fan of head and neck manipulations as the medical literature has reports of individuals incurring some serious complications of this procedure.  I suggest you get an evaluation at a comprehensive epilepsy center where your seizures and associated medical and psychological needs can be addressed in a thorough fashion.


I'm 59 years old. Last year, I was put in the hospital to see if a better medicine would help me. My medicine was taken away from me for 4 days and I was monitored. After the 4 days I was told that I do not have epilepsy and have been taken the wrong medicine all my life. I was also told that I might have anxiety. I was taking Dilantin, Mysoline and Tegretol. I no longer take Tegretol but still take Dilantin and Mysoline along with lorazepam.  I still get sick. My doctors tell me that they do not know what is wrong with me.     

This must be very confusing and distressing to you.  Some of the questions you may want to address with the doctors are if they feel you don’t have epilepsy, should they continue antiepileptic medications.  Another question is whether they feel some or all of your episodes have been psychologically-based.  If the doctors truly are unable to generate a diagnosis, you may want to get a second opinion.


What are the side effects of Valparin?   

Valparin (or Valproate) has a wide range of potential side effects.  Among them are risks of hepatitis in the face of some specific risk factors, gastrointestinal upset, potential effects on platelet counts, possible risks on hormones, and some risk to bone health.  While laundry lists of potential side effects can be unnecessarily frightening, I suggest you meet with your doctor and go over the specific side effects that pertain to you individually.  Whenever a medication is prescribed, the healthcare provider should review the risks and benefits.


Is my seizure or medication (Lamictal) causing me to have short term memory loss?

Memory problems are common in epilepsy and may have many causes including problems related to the condition giving rise to the epilepsy, medications, seizures and other issues.  Among the various antiepileptic medications, Lamictal is one of the most benign in terms of risk of memory impairment.


What is the importance of raised LDH levels in a patient after a seizure? Can a person experience psychological disturbance in patient of complex partial seizures and if so what is the reason for such psychological disturbances?    

Hormones like LDH may be checked after seizures to help clarify whether an episode was an epileptic vs. a non-epileptic type of episode.  Beyond that, there are a number of complex hormonal changes that are related to epilepsy and are the subject of many studies.  Please visit a number of the other questions in this list for a discussion of the relationship of epilepsy with psychological disturbances such as depression.


I am a female with epilepsy who has a VNS implant.  My doctor said that this might help with my depression.  Could my medication (Depakote) be keeping me depressed?  I seem to cry at everything. And this really stresses out my alert dog.  Any suggestions?   

Depakote can sometimes be associated with depression although there are many other potential causes of depression in epilepsy.  If you noted a very distinct change in mood after starting Depakote, it would be reasonable to talk to your doctor about trying an alternative. 


I take Lamictal. Can it really affect moods? Can menopause contribute also?    

The general impression of Lamictal’s effect on mood is mostly of a favorable one, with some evidence suggesting both mood stabilization and possible antidepressant properties.  However, a patient’s response to a medication is a very individual experience and can be different from others.  Menopause can certainly be associated with mood changes.

Most surgical procedures are performed for focal seizure disorders.  More uncommonly, a surgical procedure called corpus callosotomy may be performed for drop attack type seizures but this is different from the seizures of JME.  The good news about JME is that it usually responds well to medications, so that surgery would not be required anyway.  Please make sure that you are undergoing a thorough careful trial of medications if your seizures are not under control.  Rarely, a minor surgical procedure called the vagal nerve stimulator can be considered.


I was discharged from the hospital few days ago.  They did an EEG for 5 days and they endorsed my seizures because the MRI was fine. They switched me from Trileptal to Topamax 50mg. I've told the doctor that the the pressure in my head is very bad and I don't even know if this medication is right for me. I guess because he gave it ot me while I was in the hospital.  My doctor said that non epileptic seizures are the same like the real epileptic seizures. That's why he gives me Topamax and not Trileptal. What do you think? How long should I take this Topamax?    

It is difficult to give advice without knowing all the details and being your actual care provider. If I had to speculate, Topamax may have been given to you because of head pressure of pain, since Topamax is often prescribed for headaches.  The most important advice is to communicate well with your doctor, to clarify what he/she means by nonepileptic seizures, and how long you should remain on the antiepileptic drugs.  Medications should never be stopped without conferring with your doctor.


I had a grand mal seizure a year ago. The physician placed me on one 100 mg tablet of Lamictal daily.  Since this time I have gained 15 pounds, (even though I work out), my sleep patterns are all over the place, combined with anxiety, and my emotions are the same.  My relationship with my husband has taken a toll due to my weight gain.  I go back to see my physician next month and I just feel helpless. I feel that that I have no one in my corner who truly understands.  Can you give me some basic advice on how to explain to my physician all of this.  I feel like a complete idiot.    

I am sorry to hear about all the difficulties you are incurring.  Lamictal usually does not promote weight gain but an individual’s response to a medication may vary.  I am more concerned though with the global situation you are in, and your difficulties in home relationships.  I recommend you contact your local epilepsy foundation and start working with social workers and therapists that can help you address these relationship problems and how you handle them.


My mother is 67 and had been on Dilantin and diazepam (and a whole other list of drugs) for about 30 years. She has grand mal seizures. For the last year she has had weakness, nausea, burning stomach, fatigue, and lately, diarrhea. At one point, she was diagnosed with Dilantin toxicity. They altered her meds. However, after seeing doctors and running test, they do not know why she is feeling like this. She has also lost 36 lbs. since last August. Could these drugs be causing these symptoms due to prolonged use? Can any epileptic drugs do this? It's hard to watch this happen without any idea as to why. I hope you can help me.

While Dilantin can cause a number of gastrointestinal symptoms and fatigue, the only way to clarify this would be to establish a clear-cut relationship between the onset of these symptoms with the starting of Dilantin, and show the disappearance of these symptoms with discontinuation of the drug.  There are many antiepileptic drug options currently available and there may be other reasons to try alternative agents such as the risk of bone loss on Dilantin.  It would also be advisable to perform a comprehensive search for other potential causes of these symptoms.