Side Effects: Part II
The following excerpt is taken from Chapter 7 of Hydrocephalus:
A Guide for Patients, Families, and Friends by Chuck Toporek &
Kellie Robinson, copyright 1999 by O'Reilly & Associates, Inc. For
book orders/information, call (800) 998-9938. Permission is granted
to print and distribute this excerpt for noncommercial use as long
as the above source is included. The information in this article is
meant to educate and should not be used as an alternative for
professional medical care.
When people hear the word "seizure," the first thing that
usually comes to mind is a person lying on the ground, writhing with
convulsions. However, seizure activity can range from staring off into
space for a few seconds to loss of consciousness with convulsions. Numerous
medical conditions cause seizures, and treatments exist to control or
Some of the causes of seizures in persons with hydrocephalus are:
- Reaction to a drug.
- Buildup of scar tissue in the brain from operations and shunt
- Infections such as meningitis or encephalitis.
- Brain abnormalities.
- Increased ICP.
- Subdural hematoma (SDH).
- Brain tumors or cysts.
- Metabolic conditions, such as hypoglycemia (a deficiency of sugar
in the bloodstream), hyperglycemia (too much sugar in the bloodstream),
electrolyte imbalances, uremia (excessive amounts of urea, waste products
produced by the kidneys, in the bloodstream), and fluid overloads.
Children and adults with hydrocephalus are at increased risk of
seizures, particularly if there has been a complication (such as an
intracranial hemorrhage) during a shunt placement or revision procedure.
Whatever the cause of the seizures, they should be taken seriously--seek
immediate medical attention.
Although the causes of seizures vary, seizures themselves tend to follow
a general pattern.
There are essentially four phases to a seizure:
The aura phase indicates the onset of a seizure. During the aura
phase, the patient may fall into sudden unconsciousness, experience
localized muscle spasms (including involuntary jerking or shaking of
one hand, forced turning of the head, etc.), a sense of fear, false
sense of smell, or a feeling of déjà vu. The patient may
or may not experience all of these sensations. Most people have
identical auras before each seizure, helping them predict when a
seizure is imminent.
The tonic phase is when all of the muscles in the body become tense
or rigid. Patients often make noises--grunts or a shrill cry--prior to
losing consciousness. The tonic phase usually lasts from a few seconds
to a few minutes.
The clonic phase, which may or may not follow the tonic phase, is
associated with loss of consciousness, convulsions, loss of bowel and
bladder control, salivation or drooling, and irregular breathing and
heart activity. The clonic phase of a seizure can last from 1 or 2
minutes to 30 minutes or more.
The postictal phase follows a seizure. The patient may or may not
regain consciousness during the postictal phase. If he regains
consciousness, he will most likely be tired, confused, and unaware of
what happened or where he is.
Seizures do not always include the four phases mentioned here. For
instance, your child may experience only the aura phase followed by the
postictal. Or she may go from aura to tonic or clonic (one or the other),
and then to postictal.
There are two main types of seizures: partial and generalized. Partial
seizures are caused by specific areas of the brain. With partial seizures,
the physical response directly corresponds to a region in the brain where
the problem lies. The right side of the brain affects the left side of the
body, and vice versa, so if muscle spasms are on the right side of the
body, the problem will lie in the left side of the brain. It is rare that a
person who is having partial seizures will lose consciousness, although he
may feel dazed or confused following the episode.
Partial seizures are further categorized as:
Simple-partial. The person does not lose consciousness during the
The person will lose consciousness.
Secondary-generalized. The onset of the seizure can be directly
attributed to one part of the brain, which then triggers a generalized
Generalized seizures are more severe and involve both sides of the
brain. They are accompanied by convulsions, muscle activity on both sides
of the body, and loss of consciousness.
Symptoms associated with partial and generalized seizures
Type of Seizure
Interference with motor activity (i.e., muscle spasms,
Loss of consciousness
Salivation or drooling
Muscle constriction or tenseness (tonic
Bilateral convulsions (clonic phase)
Loss of bowel or bladder control
Temporary amnesia (postictal phase)
Since seizures may indicate a deteriorating neurological condition, the
condition should be evaluated immediately to determine the cause. Your
doctor will try to find out what is causing the seizures and then determine
a course of action for treating them. Tests that may be performed to
determine the cause of seizures include:
- Blood tests check for hormone imbalances, hypoglycemia, or
- CT and MRI scans look for any intracranial abnormalities. These could
include increased ventricular size, SDH, or tumor or cyst growth.
- A lumbar puncture (LP) or shunt tap looks for signs of infection, an
increased white blood cell count, or decreased glucose (sugar) levels in
the cerebrospinal fluid (CSF).
- An electroencephalogram (EEG) monitors brain waves to determine the
area of the brain where the seizure is originating.
- ICP monitoring checks for elevations or fluctuations of ICP that could
trigger the seizures.
It is a good idea to keep a log book or record of your seizures to help
your doctor properly diagnose and treat them. Information that you can
include in a seizure log includes:
- Date and time of the seizure.
- Duration, or how long the seizure lasted.
- Notes about what happened during the seizure. This could include
details about the aura, loss of consciousness, convulsions, temporary
amnesia, and how you felt afterwards.
- Notes written by people present at the time of the seizure.
This information helps your neurologist determine the frequency and type
of seizures and obtain a full picture of your seizure activity.
Seizures are treated with drugs and, on rare occasions, surgery. Doctors
can choose from a large arsenal of antiseizure medications for initial
treatment of seizures. Surgery is reserved for unusually severe,
intractable seizures or for those patients whose seizures do not respond to
Before you take any drug for seizures or give any to your child, ask the
doctor for basic information, including:
- What is the dosage? How many times a day should it be given?
- What are the common and rare side effects?
- What should I do if any of the side effects occur?
- Will the drug interact with any over-the-counter drugs (e.g.,
Tylenol) or vitamins?
- What should I do if I forget a dose?
- What are both the trade and generic names for the medication?
- Should I buy the generic version?
Each of the antiseizure medications in this section have a long list of
possible side effects. The following side effects are commonly found with
- Difficulty concentrating or processing thoughts.
- Jaundice (yellowing of the eyes and skin).
- Lack of coordination.
- Loss of appetite.
- Nausea and/or vomiting.
- Skin abnormalities, including flaking, scaling, dryness, or the
occurrence of red, blotchy spots which could indicate possible liver
- Temporary hair loss.
- Weight loss or gain.
Check with your doctor and pharmacist for a complete list of side
effects associated with any medication you are taking to control seizures.
You can also look up side effects in the PDR (Physician's Desk
Reference), located in the reference section of your local library.
Online, the OnHealth site
www.onhealth.com/) has a pharmacy section that lists
comprehensive information on more than 8,000 drugs.
There are a variety of antiseizure medications on the market for
treating seizures. Based on the test results and the type of seizures, your
neurologist will determine the best drug or drug combination to help reduce
the frequency of seizures. This section lists some of the common
antiseizure medications, including information about possible drug
interactions and side effects.
As with any medication, it is very important to take antiseizure
medication as directed by your doctor. Contact your doctor immediately at
the onset of any adverse symptoms from the medication. Be sure to ask your
doctor what to do if you should forget to take a dose of your medication.
Doubling up on the next dose can be harmful. If you forget to take more
than one dose in a day, contact your doctor before taking the next
The following list tells you the commercial names of antiseizure
medications if you know them by their generic names. After this list,
specific information about each drug is given, with the drugs arranged
alphabetically by their commercial names.
Depakene (dep-UH-keen); Depakote
Also called: Valproic acid.
How given: Tablets, taken with food if stomach irritation
Precaution: Liver damage is a possible risk of taking this
medication. If you develop yellowing of the skin and eyes, loss of
appetite, dizziness, drowsiness, weakness, and a general feeling of ill
health, contact your doctor immediately.
The one side effect I had while taking Depakote is that I was losing my
hair left and right. I was taking eight 500 mg tablets a day--at one time!
But now I'm down to taking only two tablets a day and I'm not losing as
Depakote made Chris tired and moody. He gained a lot of weight as he ate
more. He was so scrawny that this aspect was good. He's on Zarontin now,
which seems to be much better--no side effects that we've
Also called: Acetazolamide.
How given: Tablets or capsules, taken orally.
Precaution: Diamox is a sulfur-based medication that can
sometimes cause an allergic reaction, including development of a rash,
bruises, sore throat, or fever. If these symptoms occur, continue taking
your medication as prescribed and contact your doctor immediately.
Also called: Phenytoin sodium.
How given: Tablets, capsules, or syrup taken orally.
Precaution: If you have been taking Dilantin on a regular
basis, you should not stop taking this medication abruptly. Doing so can
initiate a condition called status epilepticus--repeated or
prolonged seizures with no recovery of consciousness between them. If not
treated promptly, status epilepticus can be fatal. Another possible side
effect of Dilantin is an overgrowth of gum tissues (known as gum
The only antiseizure medication that gave me adverse side effects was
Dilantin. Dilantin was the first seizure medicine I was on and it made my
gums bleed. My dentist ordered that I be taken off it
Also called: Clonazepam.
How given: Tablets taken orally.
Also called: Lamotrigine.
How given: Tablets taken orally.
Precaution: A rash may begin to form within the first 4 to 6
weeks of taking Lamictal, especially if taken in combination with Depakene.
You should notify your doctor immediately if you begin to develop a
Also called: Primidone.
How given: Tablets or syrup taken orally.
Precaution: Mysoline should not be taken if you are allergic to
phenobarbital or if you have porphyria, a rare metabolic disorder that
breaks down the red blood pigment hemoglobin.
Also called: Gabapentin.
How given: Capsules taken orally.
Also called: Luminal, Solfoton.
How given: Tablets taken orally, or injection.
Precaution: Phenobarbital is a barbiturate, and can be
addictive. Your body may become tolerant of the medication, requiring more
of the drug to accomplish the same effect.
The way I reacted to the phenobarbital was just the opposite of how one is
supposed to react to it. Instead of it calming me down, it made me really
I was on phenobarbital from the time I was one week old until three or four
years ago. The main side effect I had while on phenobarbital was drowsiness
and a lack of concentration. As my body became accustomed to the dosage,
those side effects wore off. During that time ( from age 10 to 19), I had
noticed an increased body odor. It didn't matter how much deodorant I wore,
it was never enough to rid myself of the odor caused by the phenobarbital.
Also called: Carbamazepine; Atretol, Epitol, Tegretol-XR.
How given: Tablets or syrup taken orally with food.
Precautions: Tegretol should never be taken on an empty
stomach. Tegretol increases the risk of liver and kidney disorders.
Symptoms include fever, sore throat, dry mouth, reddish or purplish spots
on the skin, and bruises. If any of these symptoms appear, contact your
I was placed on Tegretol for a few years. Slowly but surely it adversely
affected me. One Saturday we were at a large mall and I started walking
like a drunk and started showing the first signs of a shunt malfunction.
Later that day, my husband convinced me to go to the emergency room. By the
time they got around to doing an MRI and a real live doctor came to see me,
the medication had worn off and I was doing a lot better. However, my
neurosurgeon would not let me quit taking the medication--which both my
husband and I knew was the cause of all the problems.
While on Tegretol, I got lost (more than usual). I couldn't concentrate, I
had bad headaches, nausea--you name the side effect, I had it. My
neurosurgeon finally switched me to Depakote, and all the bad things went
I have no ill effects (although I know it is very hard on your liver, so my
blood is checked every three months). The one thing I have noticed is that
it helps with the partial seizures and keeps my mind intact. I just wish it
could help me regain some of my short-term memory.
Also called: Diazepam.
How given: Tablets taken orally.
Precaution: Valium is addictive. When taken as an antiseizure
medication, Valium must be taken at the same time every day.
Also called: Ethosuximide.
How given: Capsules or syrup, taken orally.
Surgery is reserved for unusually severe seizures that do not respond to
medication. On occasion, seizures may be caused by a tumor or cyst. In
those instances, surgery would be performed to remove the mass. Once
treated, the patient will be closely monitored following surgery to see if
removal of the mass has stopped the seizures from occurring.
Other surgical procedures are used as a last resort for treating
seizures that are not responsive to drugs. For example, temporal resection
surgery removes a portion of the temporal lobe to treat patients who have
focal seizures (seizures restricted to a particular region of the
Most people don't know what to do to help when someone near them has a
seizure. The myth that someone having a seizure may "swallow his
tongue" is physically impossible. Because of this myth, people tend to
do more harm than good by trying to force something in the mouth of the
person having a seizure to hold his tongue down.
The following are some dos and don'ts for helping a person who is having
seizures. (You might want to photocopy this list for people who are likely
to be nearby when a seizure occurs, such as neighbors or baby-sitters.)
What you should do
- If you do not know the medical history of the person having the
seizure, check for an emergency medical identification bracelet or
- If you know the person and know they haven't had seizures before,
send someone to call for emergency medical assistance (911).
- Make note of the time the seizure begins and how long it lasts.
This information should be given to emergency medical professionals or the
- Try to protect the person from falling down if he loses
consciousness. When he first starts to notice the aura, have the person lie
or sit down on the floor in an area that is safe.
- Move any hard or sharp objects away from the person having the
- Surround the person with pillows, blankets, or cushions, if
available. If possible, try to place some type of padding beneath the
person's head to protect him from injury.
- Try to loosen any tight clothing the person may be wearing,
including belts, ties, and shirt collars.
What you shouldn't do
- Do not attempt to place anything between the person's teeth or in
his mouth during the seizure--especially your fingers or anything metallic.
The person having the seizure might clench his teeth or bite down
unexpectedly, causing harm not only to himself, but to you as well.
- Don't hold the person down or try to restrain him during the
seizure. This could place both you and the person having the seizure at
risk of injury.
- Do not attempt to move the person, unless he is near something
immovable that could cause harm or injury to him.
- Do not yell at or get angry with the person having the seizure.
Understand that he has no control over what his body is doing; getting
upset with him will only make him feel worse afterward.
When to call for help
Since most seizures last for only one to two minutes, it isn't necessary
to call for emergency medical services (EMS) personnel immediately.
However, if the seizure lasts more than a few minutes, or if the person has
one seizure after another, you should send someone to call EMS (911 in most
states and provinces) immediately.
You should also call EMS:
- If the person has been injured.
- If the person is pregnant or suspected to be pregnant.
- If the person has diabetes.
- If the person is an infant or child.
- If the person fails to resume consciousness following the