Aphasia Strikes Again

On Monday, at about 3:30 in the afternoon, with about ninety minutes left in the work day, I had an aphasic episode. I've had episodes like this plenty of times before, but this time I was medicated and I wasn't in the middle of transitioning to a new medication.

When it hit me, I was listening to a podcast and immediately lost the ability to understand anything that was said (I recognized all the words as English, but I had no idea what any of it meant). I also felt exhausted and struggled to stay awake -- not that it mattered since I wasn't able to read or write while I was in the throws of the episode. After about twenty minutes, I was able understand what I was listening to, but I was still exhausted and couldn't concentrate. After about five minutes of futilely trying to be productive, I stood up and walked over to the desk of my boss, Magda.

She was talking with one of my coworkers, Chelsea, so I waited for a break in the conversation before speaking up. Before I had the chance to interject, Magda looked up and asked what was wrong (apparently, the feeling of extreme exhaustion was all over my face). I explained what happened, describing aphasia as a kind of micro-seizure, and said I needed to go home. She was completely understanding and Chelsea offered to drive me, which I declined -- I've had aphasic episodes while driving before and never blacked out, so I figured I was fine.

As I drove home, I talked to Leah on the phone. She also expressed concern about me driving while in my fatigued state, but I assured her I was fine. Almost on cue, I felt another aphasic episode begin before evaporating (I can feel them just before they hit, though sometimes they pass). She told me I was lucky and that I should have accepted Chelsea's offer for a ride.

The next morning, I woke up and felt sick. It felt like I had the flu and I was physically weak. I worked from home, though I was not terribly productive. Thankfully, I felt better this morning and was able to put in a full day at the office.

After talking about what happened with my neurologist, she recommended increasing my medication dosage. We increased the dosage for a few weeks last year when I first transitioned onto oxcarbazepine and it made me really drowsy. My neurologist thinks that this time I'll handle it better since my body has acclimated to the medication, but if I feel overwhelmingly tired like I did before, she has a supplemental medication in mind that we can try. For now, we're going to wait and see if simply increasing the dosage will be sufficient.

Perhaps I was foolish to think that my epilepsy problem was solved since it was under control. Maybe my life will be segmented by periods of being in control, punctuated by times when I have to look for new solutions. While I'd rather not have to worry about my epilepsy, it's under control for now and we have a possible remedy lined up if I start to show symptoms again, so things are still pretty good.

A Reasonable Solution

I talked to my neurologist about the aphasia I experienced and she increased my dosage of oxcarbazepine from 600 mg a day to 900 mg a day.  Since I increased the dosage, I have not had any aphasiatic episodes, though it's only been two days.  Still, I have reason to be hopeful.

A Worrying Series of Events

I've been on my new medication, oxcarbazepine, for nearly a month.  For the most part, I feel great.  It's the other times that have me worried.

While my depression has mostly dissipated, my anxiety has taken the opportunity to rear its ugly head again.  I don't know if my anxiety was always there and I just didn't notice it because of the depression or if only one can be experienced at a time, but whatever the case, I'm forced to maintain behaviors that will help me control my anxiety.  Thankfully, many of the same behaviors that work against depression also work against anxiety.  Also of benefit, while my anxiety has returned, I don't believe it's any stronger than it was before I started taking levetiracetam.  As far as my emotional health goes, I'm happy with the change.

Unfortunately, that's not the only issue.  Yesterday while I was at work, I experienced aphasia.  It was relatively mild, but it has me worried.  While I can chalk up the seizure I had two weeks ago to the transition, can I do the same with the aphasiatic episode?  I called my neurologist, but I haven't heard back from her yet (she works out of the local hospital and they suck at delivering messages).  Maybe the episode was due to something we can fix (maybe my dosage is too low or I have stop eating cheese or something), but it definitely has me worried.

My concern lies not only with the fact that aphasia may be a precursor for seizures, but also that I may have to switch back to levetiracetam and return to struggling to live my life.  Hopefully, I'll hear back from the doctor soon and we'll be able to solve the problem in a way that doesn't require me to switch back.

Transitional Period

I started my new medication on Monday.  Instead of levetiracetam, I'm switching to oxcarbazepine.  Because of how anti-convulsants work, I have to ease off the old medication while starting the new one.  For this first week, I take the oxcarbazepine every morning and evening while I take only levetiracetam in the evening.  Next week, I'll take oxcarbazepine just as frequently, but I'll take levetiracetam only every other evening.  The week after, the transition will be complete and I'll only be taking oxcarbazepine.

Why the transition?  While I don't know the mechanics behind it, one thing that all anti-convulsants have in common is that if you stop cold turkey, you risk having non-stop seizures (which is why the two seizures I've had since I was diagnosed with epilepsy were when I didn't get my prescription filled in time).  In fact, I made the mistake of taking the levetiracetam in the morning on Wednesday (I've gotten used to taking my medication in the morning and I wasn't thinking and kept up the habit), so I had to go longer without a dose -- while still taking oxcarbazepine regularly. Thursday afternoon at work, I started to have a minor aphasiatic episode.  Thankfully, nothing happened: I just felt it coming on before it dissipated (similar to how migraines are often preceded by halos).  I made sure I took both meds on Thursday evening.

So far, I can't say that I notice a difference.  I haven't had any seizures, but I still feel tired in the afternoon.  As for my depression, I won't be able to say if there's a difference until the weekend.  Hopefully, I'll be more motivated than I have been the last several months.

I May Have Spoke Too Soon

Remember how Wednesday's post was about how I'm finally sleeping well again after three years of being separated?  That's not untrue, but it may not be the way things truly are, either.

Because the anti-epilepsy medication I take is generic, the manufacturer can change but I'm still getting the same main chemical that keeps my brain from seizing.  I guess that happened because when I refilled the prescription last week, instead of the dark pink pills that I usually get, I was issued light yellow ones.  This is important because whenever I've been off my meds for any length of time in the past (always due to a lack of employment/medical insurance), I experience some side effect during the first week of getting back on them.  The main side effect is "drowsiness" according to the label, but feels more like "extreme fatigue."  I wrote Wednesday's post on Tuesday evening when the side effect hadn't really kicked in yet.  On Wednesday, the fatigue was so bad that I had trouble staying awake at work, despite a full night's sleep.  Yesterday wasn't so bad, so I think it's tapering off.

I bring all of this up because I may have jumped the gun in declaring my insomnia gone.  I certainly think that using delta wave music helps and I plan on continuing with that.  But when I come home feeling completely exhausted and am in bed by nine o'clock, that's not me feeling rested.  Add to that the fact that I experienced aphasia multiple times due to my exhaustion and I knew something wasn't right.

If my assumptions are correct, I should be back to normal by early next week.  With any luck, that will include going to sleep easily, but not being exhausted.

Unexpected Experience

Last week I was in charge of a Young Men's-hosted dinner.  Technical the Teachers were in charge, but I was offered a more direct role in the planning, so I took it.  Unfortunately, the dinner (which was not for the whole ward, just the senior members) was planned for Wednesday night, so I was at work and wasn't able to do any cooking.  Thankfully, I was able to get some parents to help out and all I had to do was buy and prep all the ingredients.  With everyone's help, it was all a huge success.

That's not what this post is about.

While I was in the kitchen getting everything ready (stirring, mixing, slicing, etc.), I experienced an aphasiatic episode.  The episode itself was mild enough, but what really worried me was this was the first time that I've had one while fully medicated.  In the past, as long as I took my meds -- even once-a-day instead of the prescribed twice -- I never had to worry about aphasia.

However, one episode could just be a fluke.  When I haven't been able to afford my medication, I was usually okay if I watched my blood-sugar and got enough sleep, though it was no guarantee.  Having reviewed everything in my mind, I was little sleep deprived and I hadn't had dinner when I arrived at the church, which may have pushed me over the edge even though I was medicated.  I guess I'll need to take the same precautions as when I don't have access to my meds, just with the view that being medicated is a bit of a bonus.

If this happens again when I'm medicated and my blood-sugar's fine and I'm well-rested, then I'll be concerned.

Side Effects

Due to a mix-up at work, I didn't sign up for my benefits when I was supposed to.  Luckily, I have a very patient HR director that was willing to help get everything worked out.

I bring this up because I only got my prescription card this week.  Since I had to wait for my card, I wasn't up-to-date on my anti-seizure medication.  I hadn't been on it since a little before Christmas, but as long as I monitored my blood-sugar level, I was fine.

At least I was until last week.  While at the gym on Saturday, I had a minor aphasia.  I was on the treadmill at the time and it wasn't severe enough to make me get off, but I did have to slow down.  I figured it was just my blood-sugar being low from the exertion.  Then I had another one at my desk on Monday.  It was still a little one, but it started making me nervous.

I'd had had two more tiny ones on Tuesday by the time I made it home to find my prescription card in the mailbox.  I immediately went to the pharmacy to get my medication.  I haven't had another aphasia since I got my prescription.

What I have had, however, is noticeable fatigue.  One of the side effect I experience during the first week or two of getting back on my meds is feeling tired.  It's not exactly drowsiness or sleepiness (though it is much harder getting up in the morning), it's just generally feeling run down.  The last time I went through this when I first got on my meds a little over a year ago, I got over it in a couple of weeks, so I'm expecting the same thing to happen this time.

It's annoying, but at least it's temporary.

Weekend of Failure

So that trip to the Temple that I was planning to make on Saturday?  Didn't happen.  I woke up on Saturday and discovered that I had a tremendous headache and I was really dizzy.  It was so bad that I had trouble standing without falling over.  I'm sure to any outside observer that it looked like I was on a boat or something.  Because of this, I didn't go to the temple and mostly tried to nap.

On Sunday, I felt much better.  I was looking forward to Church after missing it last week and not making it to the temple the day before.  However, after I had gotten out of the shower and was finishing getting ready, I had an aphasia.  I had missed my medication the day before - I simply forgot - and apparently it made a big difference.  Once I could talk, I called the Sunday School President to explain what had happened and that I wouldn't be coming.  He was very understanding, but I hate that this has been happening off and on since I was called to be a teacher.

I realize that my body shutting down is out of my control, but I can't help but feel that the last two days were wasted.  Here's hoping that next weekend will go better.