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Transient Epileptic Amnesia

Dear Dr. Dean,

I read with interest your article on seizures.  I am 69, and started having partial seizures about 5 years ago–pretty much daily, 1-4 seizures that manifested as extreme deja vu (seizures confirmed with a stay in the hospital).

I tried drugs, but they didn’t stop the seizures and made me very ill–nausea, etc, so quit taking.  I take no other drugs.

I also started having transient epileptic amnesia (TEA), about once a month for maybe the last 3 years.  When I went on a high fat/low carb ketogenic type diet two years ago, my partial seizures went away.  However, I still continue to have the TEA episodes.

I am on a nutritional balancing program (NB) where I do hair analysis (also read your article on hair analysis) every 3 months to determine supplementation.   Do you have any advice about Transient Epileptic Amnesia?”

Thanks,

1 answer

Hello,
Transient epileptic amnesia is a rare condition for which no established treatment has been found. Consider my suggestions as educated guesses.
If you’ve read much of my stuff, you probably know that I tend to be a big proponent of the anti-epileptic drug gabapentin, as a sleep enhancer. Gabapentin actually improves normal sleep, by enhancing all four phases of sleep.1 I’m not sure what anti-epileptic drugs you’ve taken, but if you haven’t taken gabapentin, I would recommend adding it to your present regimen. You’ll benefit from the anti-seizure effects of Gabapentin, as well as its sleep-enhancing properties. Gabapentin’s cognitive effects in those with seizure disorders appear to be at least neutral2—and may even be positive.3 In any case, the sleep-enhancing effects of Gabapentin should be beneficial—to say nothing of its anti-seizure effects.
Considering your current situation, another anti-epileptic medication to consider for daytime use is Keppra, (Levetiracetam). Levetiracetam is a pyrrolidone derivative structurally similar to the nootropic prototype, Piracetam (Fig.). In fact, Levetiracetam was initially intended as a cognitive enhancer, with the hope of finding a cognitive-enhancing drug even more effective than Piracetam. Piracetam was known to significantly improve learning and memory; in contrast, Levetiracetam was initially determined to have less effect as a cognitive enhancer, but was more active in preventing seizures.4
Nevertheless, a number of subsequent studies indicate that in addition to its anti-epileptic properties, Levetiracetam also appears to be “rising to the occasion” as a cognitive enhancer. It improves reaction time, tapping rate and memory;5 improves cognition/behavior in children;6, 7 improves executive functions, psychomotor speed, concentration and remote memory;8 and increases quality-of-life scores.9, 10 Levetiracetam has also improved a range of cognitive abilities, including visual short-term memory;11 prospective memory, working memory and motor functions;12, 13 psychomotor speed and concentration;14 fluid intelligence;15 and improvements on the Mini-Mental State Examination.16, 17 Levetiracetam also improved health-related quality of life over a four-year period,18 improved cognition in patients with medically-refractive partial seizures,19 improved cognitive outcomes in patients with intracranial hemorrhage,20 and improved verbal memory in high-grade glioma patients.21
Dosage
Sleep-inducing dosages of Gabapentin usually range from 600-800 mg at night, although a few patients get by on as little as 100mg, and some require heroic dosages as high as 3200 mg. For Levetiracetam, the initial dose is 1,000 mg/day, given as 500 mg twice daily, with additional dosage increments up to a maximum recommended daily dose of 3,000 mg—although doses higher than 3,000 mg/day have been used in open-label studies for periods of six months and longer without adverse effects.
Let me know how you do,
Ward Dean, MD
References

  1. Lo HS, Yang CM, Lo HG, Lee CY, Ting H, Tzang BS. Treatment effects of gabapentin for primary insomnia. Clin Neuropharmacol. 2010 Mar-Apr;33(2):84-90.
  2. Leach JP, Girvan J, Paul A, Brodi MJ. Gabapentin and cognition: a double blind, dose ranging, placebo controlled study in refractory epilepsy. J Neurology, Neurosurgery, and Psychiatry, 1997;62:372-376
  3. Mortimore C, Trimble M, Emmers E. Effects of gabapentin on cognition and quality of life in patients with epilepsy. Seizure. 1998 Oct;7(5):359-64.
  1. Genton P, Van Vleymen B. Piracetam and levetiracetam: close structural similarities but different pharmacological and clinical profiles. Epileptic Disord. 2000 Jun;2(2):99-105.
  2. Neyens L, Alpherts W, Aldenkamp A. Cognitive effects of a new pyrrolidine derivative (levetiracetam) in patients with epilepsy. Prog Neuro Psychopharmacol Biol Psychiatr 1995; 19: 411-9.
  3. Wheless JW, Ng YT. (2002) Levetiracetam in refractory pediatric epilepsy. J Child Neurol 17: 413–415.
  4. Von Stülpnagel C, Kluger G, Leiz S, Holthausen H. (2010) Levetiracetam as add-on therapy in different subgroups of ‘‘benign’’ idiopathic focal epilepsies in childhood. Epilepsy Behav 17: 193–198.
  5. Helmstaedter C, Witt JA. (2010) Cognitive outcome of antiepileptic treatment with levetiracetam versus carbamazepine monotherapy: A non-interventional surveillance trial. Epilepsy Behav 18: 74–80.
  6. Wu T, Chen CC, Chen TC, Tseng YF, Chiang CB, Hung CC, et al. (2009) Clinical efficacy and cognitive and neuropsychological effects of levetiracetam in epilepsy: an open-label multicenter study. Epilepsy Behav 16: 468–474.
  7. Cramer JA, Arrigo C, Van Hammee G, Gauer LJ, Cereghino JJ. (2000) Effect of levetiracetam on epilepsy-related quality of life. Epilepsia 41: 868–874.
  8. Ciesielski AS, Samson S, Steinhoff BJ. (2006) Neuropsychological and psychiatric impact of add-on titration of pregabalin versus levetiracetam: a comparative short-term study. Epilepsy Behav 9: 424–431.
  9. López-Góngora M, Martínez-Domeño A, García C, Escartín A. (2008) Effect of levetiracetam on cognitive functions and quality of life: a one-year follow-up study. Epileptic Disord 10: 297–305.
  10. Rosche J, Uhlmann C, Weber R, Froscher W. (2004) Different cognitive effects of inducing levetiracetam or topiramate into an antiepileptic pharmacotherapy in patients with therapy refractory epilepsy. Neurol Psychiatr Brain Res 11: 109–114.
  11. Helmstaedter C, Fritz NE, Kockelmann E, Kosanetzky N, Elger CE. (2008) Positive and negative psychotropic effects of levetiracetam. Epilepsy Behav 13: 535–541.
  12. Rosche J, Uhlmann C, Weber R, Froscher W. (2004) Different cognitive effects of inducing levetiracetam or topiramate into an antiepileptic pharmacotherapy in patients with therapy refractory epilepsy. Neurol Psychiatr Brain Res 11: 109–114.
  13. Lippa CF, Rosso A, Hepler M, Jenssen S, Pillai J, Irwin D. (2010) Levetiracetam: A practical option for seizure management in elderly patients with cognitive impairment. Am J Alzheimers Dis Other Demen 25: 149–154.
  14. Wu T, Chen CC, Chen TC, Tseng YF, Chiang CB, Hung CC, et al. (2009) Clinical efficacy and cognitive and neuropsychological effects of levetiracetam in epilepsy: an open-label multicenter study. Epilepsy Behav 16: 468–474.
  15. Cramer JA, Van Hammée G. Maintenance of improvement in health-related quality of life during long-term treatment with levetiracetam. Epilepsy Behav. 2003 Apr;4(2):118-23.
  16. 19. Zhou B, Zhang Q, Tian L, Xiao J, Stefan H, Zhou D. Effects of levetiracetam as an add-on therapy on cognitive function and quality of life in patients with refractory partial seizures. Epilepsy Behav. 2008 Feb;12(2):305-10. Epub 2007 Nov
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