My dad is currently in the hospital, and the doc is treating his seizures with Dilantin. He’s experiencing hallucinations that are believed to be a result of the Dilantin.
The doc is old and Dilantin has been around for a long time; it may be that he’s prescribing it because that’s what he’s most comfortable with. In fact, I’ve recently read that Dilantin should not be given to patients with Parkinsons disease (yes, my dad has PD).
I’d like to suggest alternative anti-seizure meds to the doc - ones that don’t produce hallucinations.
Mods, please keep in mind I’m not seeking medical advice for self-treatment; I’m asking for information to present to my dad’s doc.
Wait a minute you have a father who is in hospital and his doctor is giving him a medicine which is causing him to hallucinate? And you feel the need to ask a message board for an alternative?
I am not faulting you at all, you have to ask, but if I had to do this, I would immediately drop the doctor and find a new one. Why is this doctor giving your dad something that is going to make him hallucinate? Much less give him a drug that shouldn’t be given to a person with a condition the patient has?
I’m not being critical of the original poster, but you need to get a doctor you have confidence in. I hope someone can help this person out with some better drug information. And I hope the original poster finds a better doctor to treat the father
Lots of 2nd generation AEDs (anti-epileptic drugs) out there with fewer side effects than dilantin, and most of them are just as effective, if not moreso.
Personally I prescribe a lot of tegretal and depakote. But I’ve also a few patients on Keppra, neurontin, lyrica, and topamax.
However, a doc should be deciding which one to use, based on your dad’s clinical situation and co-morbid conditions.
Thanks for the suggestions; I will research these a bit and bring them up with the doc.
Agreed, and since these are Rx meds, it’s most definitely out of my hands; I just want to suggest alternatives for the doc to consider, since the Dilantin might be causing the hallucinations.
It’s also important to realize that when an elderly (I assume your dad is over 70 or so) person, with epileptic seizures, PD and God knows what other medical conditions, is admitted to hospital, there are about 473 reasons why they might be hallucinating.
In fact, I am referring to delirium which complicates many older people’s course in hospital. The Wiki article, which looks pretty good, conveys a bit of the complexity of the problem.
Of course, it’s also worth noting that the L-Dopa commonly used to treat PD is, itself, a common cause of hallucinations. Even someone who hadn’t previously hallucinated due to L-Dopa treatment, might very well begin to do so in the setting of an acute medical illness (such as seizures, infection, heart attack, dehydration, kidney problems, etc, etc) especially when new drugs are being introduced into his/her treatment regimen, i.e. drug interactions.
I’m on a combination of Lamictal and Zonegran. The worst side-effects there are drowsiness. I’m on a pretty high dosage of the former, so I’m always sleepy, but it beats the alternative.
(I was recently dropped by my neurologist for not having insurance – they won’t take self-pay, or I’d ask him.)
If not then your being dropped by the physician you have an established realtionship with when you have never not paid a bill, kept appointments, not been abusive, etc. … may constitute patient abandonment. You may want to consider reminding the neurologist that abandoning patients exposes a doctor to huge liabilities and if he does not reconsider then consider reporting the behavior to the state board.
Very true. However, if the doc gave 30 days notice, that generally makes it legal in most (?all) states.
Docs are free to select or deselect patients for any reasons that don’t involve protected classes. They must do it in a stepwise manner to avoid patient abandonment, however.
Perhaps it varies from state to state but my Medical Malpractice carrier sponsored Risk reduction continuing education lecture stated otherwise. According to them giving 30 days is just part of what is required. You must also have valid cause, which includes failure to pay bills, failure to comply with the medical plan, missed appointments, abusive or threatening behavior, and possibly a few others that I am not recalling right now. But “deselection” cannot be done for any reason at all according to them. Also if a patient cannot find a physician who can care for their problem I am obligated to help them find one and care for them until they do. As part of our large groups QA/UM committee we have patient dismissals come through us all the time and documentation of one of those items is required before dismissal can occur.
I checked my state medical society’s recommendations, and they recommend one only do it for cause, and document, document, document. However, the state statutes don’t seem to spell out what cause is, and emphasize the patient notification and time period aspects of it.
I agree with my society and your malpractice carrier’s recommendations. But perhaps they were basing those recommendations on malpractice risk or board action rather than legal requirements?
In my current position, I can’t really fire any of my patients, even if they try to kill me. :dubious:
I was supposed to make my yearly appointment and was informed they no longer accepted those who don’t have insurance*. Now my regular doctor is prescribing my meds. Fortunately, I haven’t had a seizure in over a year and a half knock on wood, but of course, that doesn’t mean anything. (Epilepsy being very unpredictable)
She said she could reccomend a good neurologist in a the meantime, but I’ve run into this before – there ARE doctors out there now who won’t take patients without insurance.
*You should have heard the words coming out of my mouth after I hung up the phone! Fortunately I was home by myself and I was able to yell and swear as loud as I wanted.
This appears to be the case. He had been taking Amantadine for the PD, stopped last month (without telling his PD doc) and then started again last week (at higher dosage, on advice from PD doc). That appears to coincide with the onset of the problems that brought him to the ER (falls, confusion, imbalance, weakness). He finally got a message from his PD doc and stopped the Amantadine on Saturday morning. The hallucinations started soon after that. Doc actually increased the Dilantin dosage on Saturday evening. By Sunday morning he was doing much better: lucid, very little confusion, and aware that he had been hallucinating the day before.
Amantadine has a half-life of about 12 hours, so the starting/stopping of it seems to match his symptoms nicely. It would appear that the Dilantin itself is not the problem (although who knows what interactions were taking place).
Anyway, things are much better and he’s likely to be discharged in a day or two.