Expert: Dr Alan Galbraith - 11/2/2009

Question
My wife had an AVM in Sydney, AU 2 yrs. ago. Dr. Rodney Allen performed the surgery.  She is on tegretolfor seizures.  SHe went 18 months without. In March of 09 she had a seizure after takinf a pain pil.  Eight months later on 10/30 she had another seizure after having a Depro-Medrol 60mg.(steriod) injection in her hip.  Doctors (neurologist just increase the tegtetol dosage.  I have researched the interactions and it appears to me that the drug interactions may be causing the seizures.  Can you provide any additional information.  Additionally, as US citizens I cannot tell you enough how outstanding we think the medical care is in AU.  The Royal Prince Alfred Hospital, Dr. Allen and his staff were outstanding.

Answer
Dear John

It is true there are many drug interactions with Tegretol and the ones to be careful of are those that can potentially lower its blood concentration. Neither pain killers or Depo-Medrol should cause this but anything is often possible even though not reported before and its seems too much of a coincidence not to be related.

I would suggest a change of drug, there are plenty antiseizure drugs to choose from but the selection really must be done by her neurologist as there are several types of seizures and all can respond slightly differently to the available drugs. If suitable, the one I would recommend is lamotrigine. Speak to her neurologist and suggest a change of drug regime. The newer antiseizure drugs also have less adverse effects than Tegretol when used as prescribed.

Regards

Alan Gabraith