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robjw

Altitude Change and Medication Effectiveness?

Hi - I've been diagnosed with epilepsy for about 15yrs (am now 43yrs). Until Christmas last yr I was seizure free for 7 yrs. We went on holiday for 2 weeks down to the coast and then returned to altitude in Johannesburg (6 000ft?) and 2 days later I had a seizure - my mediction was increased by 50% and was then found to be in the therapeutic range. Then 2 days ago it happened again after coming back from holiday at the same place. My meditation is Convulex (3x300mg/day) i.e. valproic acid. My pharmacist thinks there may be a link with haemoglobin level changes with altitude and medication effectiveness - any ideas?

Comments

RE: Altitude Change and Medication Effectiveness?

hi, yes - i have also read and heard that high altitude can cause seizure problems. but plenty of web sites claim there is no problem. this has happened to you twice, so i would think it is related. but if this is the only time you have a seizure, what do you think about increasing or changing meds? it seems a little extreme when you have so few seizures and they have only occured after change in altitude. i wonder what your blood levels looked like before you left and after you returned home. that might be an interesting experiment. it would be interesting to know if your levels were decreased - and if so - how long it would take for them to return to normal. maybe part of the problem is that the altitude change was too sudden. i don't know if you drove or flew, but either way would be much faster than walking. 6,000 ft is just not that high and that's your "home altitude" and you were only gone two weeks. it seems like it is a problem for you. it just surprising in some ways because you are very accustomed to the higher altitude. but that's the way altitude is - very individual. i do fine at high altitude because i walk in and i've been lucky. 20,000 ft has not been a problem for me, BUT today i drove from sea level to 1,200 ft and my ears are still bothering me. altitude related problems are very unpredictable, even within the same person. fitness doesn't guarantee immunity from altitude issues. there's a bit about epilepsy and altitude here. it doesn't explain the mechanisms of altitude induced seizures. you'll need to scroll toward the bottom. http://www.himalayanrescue.com/AltitudeIllness.htm

RE: Altitude Change and Medication Effectiveness?

Thanks for the reply "Tibet2"!Well - maybe that's that theory out the window - I had another VERY mild seizure this morning.... after having increasing medication by about 25% over the last 2 days - this morning was 4 days since coming up from sea level..... Obviously a visit to the neurologist is needed!

RE: Altitude Change and Medication Effectiveness?

rob, sorry about the second seizure. i don't know that the altitude theory is out the window. four days is not that long to be back. i would think that it would take "awhile" for your system to get back to "normal' - though what "awhile" might mean is not clear to me. i read some of the climbing literature and altitude issues are very flukey. it's a little trite - but the three cures for altitude problems are "descent, descent, descent." so maybe you need to go back on holiday ;-) maybe the real problem is johannsburg stress ;-) raising meds by 25% after just having raised them 50% last year is a big increase. maybe you have "refracted" to your med (your med has lost its effectiveness - that sometimes happens after "awhile") it's also possible the mild seizure was caused by the increase in meds. anti-convulsants can cause seizures. changes in dosage can cause seizures.you're right - a visit to the neuro is needed. what kind of seizures do you have?

RE: Altitude Change and Medication Effectiveness?

Going back on holiday sounds an EXCELLENT plan - thanks - will inform my boss and take out a loan since I'm now broke! Tried to see my neuro 2 days ago but he was also on holiday! His stand-in gave me the advice to increase the meds in the mean time.... My regular neuro should be back tomorrow. From my recent (today!) reading I probably relatively often have very early morning (within 30min of waking) "Absence" and "Myoclonic seizures" (about one a month) but the ones I had in the last week and the one in December last year (all very early morning) were probably "Tonic-clonic" in December and "Atonic" this last week - I was definitely unconcious (so couldn't diagnose myself!) but according to my wife (and the neuro for the December one) this sounds about right. Had a brain scan in December so that rules out tumour etc. I think a typical EEG conclusion is "Mild to moderatey abnormal EEG. A right hemispherical dysfunction maximal in central temporal and anterior temporal regions is noted. Features are non-specific ion nature"Thanks again for the thoughts and ideas.

RE: Altitude Change and Medication Effectiveness?

if only i were a neuro and i could convince insurance companies to finance vacations instead of increased anti-convulsants.... we could all have a "working holiday" and go help chad with his forum in zambia...it must be very difficult for your wife to sort out what happened when you had those seizures because it happens so quickly and must be very distressing to her. the first time i saw a friend have a partial seizure i had no idea what was happening, just that he wasn't well. at that point i didn't know he had epilepsy. i think were one of my children or my husband to have a seizure i would not be the best witness. i hope i am never put to the test on that one. are you familiar with juvenile myoclonic epilepsy (JME)? don't let the name mislead you - it is often not diagnosed until a person is in their 20s or older.... and contrary to the expectation you might have because of the name - it is not a condition you outgrow. i only ask because the hallmark of JME is myoclonic seizures upon awakening and you are taking the med that works best for JME. if your sleep cycle is off that might be part of the problem with seizures following holiday. http://www.emedicine.com/NEURO/topic416.htmhttp://www.epilepsy.org.uk/in...'m hopeless, positively hopeless, with EEGs, so i can't help you out there. hopefully i am going to learn a little something about them over the next few months, so maybe then i will have a vague understanding of what that EEG summary means. it is abnormal. if the literature on JME sounds familiar to you, you might want to ask the neuro about it. there are anti-convulsants that you would want to avoid if you have JME. good luck. hope you get in to see the neuro soon.

RE: Altitude Change and Medication Effectiveness?

Well - I went to the neuro today and what was his diagnosis? - JME!!! Who needs a neuro when you have a community! He increased my meds somewhat - still within the right dosage range for my weight and I'm sure the blood levels will be within the upper limit of the therapeutic range - I'm very happy with Convulex (i.e. Valproic Acid) few side effects and have controlled my seizures very will for many years - the conclusion today was that I'm rather stressed and my sleep patterns had deteriorated recently. Thanks for the links etc - will read tomorrow - need to get some sleep ......

RE: Altitude Change and Medication Effectiveness?

Hi Rob. Glad to hear that your diagnosis came in.A good guess by your neuro regarding JME,and sounds as if he/she is confident regarding your blood levels being at a theraputic level.You cannot beat the benefits of a good night's sleep either,so enjoy,let it help alleviate the stress.Sorry we can't send you back on holiday.Though your treatment sounds as if it's suiting you.If you check out the link I've enclosed you should learn a bit more about JME and sodium valproate.A good drug,so far found to be the best at treating JME by stabilising the electrical nerve activityand preventing sodium from entering the nerve cells when they begin to fire rapid and repetitive electrical signals. A build up of sodium in the nerve cells is necessary for an electrical signal to build up and be passed on, so sodium valproate may also prevent seizures in this way.As in your case. The link I found as well regarding altitude,is quite interesting from a different perspective.Good luck.Harish.http://www.roadandtravel.com/health/altitudesickness.htm

RE: Altitude Change and Medication Effectiveness?

rob, that's wonderful that you got in with the neuro so soon! JME was something i was unfamiliar with a few years ago. but if you read enough you end up remembering a few things ;-) there was a recent thread on this board concerning a woman with JME who was considering pregnancy, so we were just talking about it a week or two ago. you will have to be careful with your sleep. but the good news is JME responds well to medication and if you are careful with your sleep that should help as well. everyone with E should be careful with their sleep, but JME is particularly sensitive to sleep.

RE: Altitude Change and Medication Effectiveness?

I'm sure my life will get back to "normal" in the next couple of weeks. I suppose epilepsy is usually something like alcoholism - once an epileptic always an epileptic one just can't afford to become complacent. Fortunately I think I have come to live with it and accept it. Finding www.epilepsy.com and this forum/community has been a very positive experience - thanks Tibet and Harish for your input and support.

RE: RE: Altitude Change and Medication Effectiveness?

I had read this the time you posted but, just today as I was going thru the archives, it sounded much more interesting.I have outlived my problem! great achievement for me. I do not remember when I had my seizure and proud am I to speak to people about it, convincing everyone out of their stigma. Living with epilepsy is now not a hurdle to jump, but a challenge to meet.Happy 2005 to all of you friends and communityCHAD

RE: RE: Altitude Change and Medication Effectiveness?

our daughter has left temp seizures and when we went to arizona it drove her nuts with the altitude.  then when we fly somehweres it also bothers her.  sometimes it seems that it bothers her for up to a week when we get back

RE: RE: Altitude Change and Medication Effectiveness?

hello my meda at higher levels cause sezure activety to get worse. the lower dosesslow the amont of sezures. but sofar nothing has stoped them or controled them. masterdelve