>> Tuesday, November 27, 2012
Glenn has often wondered why I frequent Facebook. He no longer wonders.
In the course of reading through posts in Kids With Epilepsy I came across a fact that I had not heard before:
Lamictal can inhibit Folate.
What? It's an Na Blocker...SODIUM...not Folate. But, oh, how it is. I researched and sure enough, on GSK's own .PDF about Lamictal we find this:
"Folate concentrations were also reduced in male rats given repeated oral doses of lamotrigine. Reduced concentrations were partially returned to normal when supplemented with folinic acid."
Knowing that Lamictal and Phenytoin have a similar mechanism of action I decided to look into that as well and what did I find?
"Serum folate decreases when phenytoin therapy is initiated alone with no folate supplementation. Folic acid supplementation in folate-deficient patients with epilepsy changes the pharmacokinetics of phenytoin, usually leading to lower serum phenytoin concentrations and possible seizure breakthrough. Folate is hypothesized to be a cofactor in phenytoin metabolism and may be responsible for the "pseudo-steady-state," which is a concentration where phenytoin appears to be at steady-state, but in reality, is not. Phenytoin and folic acid therapy initiated concomitantly prevents decreased folate and phenytoin obtains steady-state concentrations sooner." - 1995 Jul-Aug;29(7-8):726-35.
Phenytoin-folic acid interaction.
Lewis DP, Van Dyke DC, Willhite LA, Stumbo PJ, Berg MJ.
College of Pharmacy, University of Iowa, Iowa City 52242, USA.
Why is this important? Because Bug has folate issues anyway, his body fights it and his brain is starved of it and we are inhibiting that. Oh goodie. Now, we are supplementing him with Folinic Acid but...we are also fighting ourselves. Making it worse, while trying to help.
I also found that there are additional Genetic tests that can be performed to see if he has a mutation.
I could cry.
Bug had a bad seizure at school yesterday. They had never seen such a dramatic Tonic Clonic before. From the description, it sounds like he had some Todd's Paralysis after as well. Damn. So, I am in research mode and not very happy. BUT, that is how things get done, and how we find answers and how we help our little man. He has an appointment in March to discuss this with his Neuro. What are the odds I will wait that long?