PMC2632796_01
PB withdrawal seizures as a function of the daily doses of PB and LTG. PB was tapered by 30 mg every three weeks. On the second week that the patient was on PB 60 mg/d, a LTG titration was started with the first week being a daily dose of 25 mg/d. Data are reported as the number of seizures per week.
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However, as shown in Fig. 1, when the patient reached doses of PB 60 mg/d and LTG 25 mg BID, complex partial seizures occurred. Her PB blood level was 7 mug/ml when the seizures started (Fig. 1).
PB withdrawal seizures as a function of the daily doses of PB and LEV. PB was tapered by 15 mg every three weeks. The dose of LEV was increased as shown in the graph. Data are reported as the number of seizures per week.
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BID (Fig. 2). Because of the seizures, LEV was increased further to 1000 mg BID. When the patient was on PB 15 mg/d and LEV 1000 mg BID, four seizures occurred over a three-week period (Fig. 2). The seizures continued for three weeks after discontinuation then stopped (Fig. 2).
Aura frequency during the 24 months after cessation of PB withdrawal seizures. After the PB withdrawal seizures had stopped, the frequency of auras was recorded. Before the PB taper, when the patient was taking PB 150 mg/d, her baseline aura frequency for more than a year was two auras per month. Data are reported as the number of auras during the previous 30 days. Data were collected for 24 months after her last PB withdrawal seizure.
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The frequency of the patient's auras remained above her baseline of two auras per month for six months immediately following cessation of PB withdrawal seizures (Fig. 3). Starting at seven months after PB cessation, her aura frequency decreased to her baseline aura frequency of two auras per month (Fig. 3) and her anxiety symptoms resolved.