Post-Surgery Anxiety and Restlessness from New Antiepileptic Medication

Q: Post-Surgery Anxiety and Restlessness from New Antiepileptic Medication

Hello： You can first discuss your concerns with the primary care physician. <br>If the primary care physician is unfamiliar with the medications, they typically consult with a specialist at the hospital via phone, which is the practice at our institution. <br>Regarding the medica

Post-operative agitation and anxiety as side effects of using the medication Uriel after a subdural hematoma surgery?

Hello Doctor, my father is 66 years old and has a history of epilepsy, Parkinson's disease, and head trauma.
He used to take two tablets of Depakene 500mg and Keppra daily to control his epilepsy, along with Parkinson's medications, Mirapex and Sinemet.
His condition was quite stable.
However, last month, he fell at home and sustained a head injury that led to a subdural hematoma, requiring surgery and hospitalization.
During his hospital stay, he experienced frequent seizures, and the doctors prescribed several antiepileptic medications for him.
After his condition gradually stabilized, he was discharged.
Currently, my father is taking Valproic Acid liquid formulation twice daily, 800mg (8cc) each time, and two tablets of Felbamate 10mg to control his epilepsy.
For his Parkinson's disease, he is only taking three tablets of Mirapex 200mg daily.

Since starting the new antiepileptic medication, he has been experiencing significant agitation, restlessness, insomnia, and has been unable to sit still for several days.
I searched online for information and am unsure if these symptoms are side effects of Valproic Acid.
Currently, my father is bedridden and has limited mobility, making it difficult to return to the hospital for a medication adjustment.
We can only call an ambulance to take him to the hospital.
A home doctor is scheduled to visit on December 4th, but since my father is on neurology medications, I am uncertain if the home doctor can change his medications, specifically switching Valproic Acid to another antiepileptic drug.
Family members mentioned that antiepileptic medications cannot be adjusted arbitrarily.

What should I do at this point? Should I call an ambulance to take my father to the hospital for evaluation and medication adjustment, or should I wait for the home doctor on December 4th to make the adjustments? If medication changes are necessary, can I request the home doctor to switch Valproic Acid to another antiepileptic medication, or will he need additional medications for anxiety or sleep? Thank you, Doctor.

James, 20~29 year old female. Ask Date: 2019/11/20

Dr. Jiang Junyi reply Neurology

Hello: You can first discuss your concerns with the primary care physician.
If the primary care physician is unfamiliar with the medications, they typically consult with a specialist at the hospital via phone, which is the practice at our institution.
Regarding the medications Depakote and Lamictal, they are more effective for mood stabilization compared to Zyprexa.
After switching medications, although the seizures are under control, the effectiveness of mood stabilization may decrease.
I recommend that you schedule an appointment to discuss the medication responses with your father's attending physician.
Whether to call an ambulance to the hospital should be determined by your father's attending physician based on his condition.
Wishing you and your father good health and peace.
Sincerely, Dr.
Jiang, Department of Neurology, Taoyuan Hospital.

Reply Date: 2019/11/20

More Info

It sounds like your father is experiencing significant distress following his recent surgery and the introduction of new antiepileptic medication. Given his medical history of epilepsy, Parkinson's disease, and head trauma, it's understandable that you are concerned about his current symptoms of restlessness, anxiety, and insomnia.
Firstly, it's important to recognize that many antiepileptic drugs (AEDs) can have side effects that may include mood changes, anxiety, and sleep disturbances. The medication your father is currently taking, which includes "優閒液劑" (likely referring to a liquid formulation of a specific AED), may be contributing to his feelings of agitation and restlessness. While these medications are effective in controlling seizures, they can also affect mood and behavior, particularly in elderly patients or those with complex medical histories.

Given that your father has been stable on his previous medications, the recent changes in his medication regimen following his surgery could be a significant factor in his current state. The abrupt introduction of new medications, especially in the context of a recent head injury, can lead to unpredictable side effects. It is also possible that the combination of medications he is taking for epilepsy and Parkinson's disease could be interacting in ways that exacerbate his symptoms.

In terms of managing his current situation, it is crucial to ensure that he receives appropriate medical attention. If his symptoms are severe and impacting his quality of life, it may be necessary to seek immediate medical care. Calling an ambulance to take him to the hospital for a thorough evaluation could be warranted, especially if he is unable to manage his symptoms at home.
However, if the symptoms are manageable and you feel that he can wait until the home doctor visit on December 4th, it may be beneficial to allow that appointment to take place. The home doctor can assess his condition, review his current medications, and determine if any adjustments are necessary. It is essential to communicate all of his symptoms clearly to the doctor, including the onset of anxiety, restlessness, and sleep issues, as these details will help guide treatment decisions.

Regarding the possibility of switching medications, it is generally not advisable to make changes to antiepileptic medications without medical supervision. These medications often require careful titration and monitoring to avoid seizure exacerbation. The home doctor may suggest alternative medications or adjunctive treatments, such as anti-anxiety medications or sleep aids, to help alleviate his symptoms while maintaining seizure control.

In summary, your father's current symptoms may be related to the new antiepileptic medication, and it is essential to address these concerns with a healthcare professional. Whether you choose to seek immediate medical attention or wait for the home doctor visit, ensure that his symptoms are communicated clearly to facilitate appropriate management. It is crucial to prioritize his safety and well-being during this challenging time.

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