I had a benign meningioma removed in August 2019, I was on anti-inflamatory meds for a week and anti-seizure for a month after surgery. I had no seizures before or immediately after surgery. In April 2020 I had multiple tonic-clonic seizures, back to back, i didn't regain consciousness before the next started. I was taken to the hospital, put on a ventilator and kept sedated for a day and a half and put on 3000mg of Keppra a day. From what I understand, because I had multiple Tonic-Clonic seizures, I am now considered an epileptic. My neurologist says I may be on Keppra the rest of my life to stop seizures, which could be caused by the scar tissue from the surgery. My Neurosurgeon says this generally doesn't happen (scar tissue from meningioma surgery is generally well tolerated), but can in some cases. I am having a lot of side-effect issues from the Keppra. I am 60 years old, 5'6" and 140 lbs in good shape - I exercise a lot. From what websites I have been able to find concerning the dosage of Keppra, dosage guidelines are provided for children, but the dosage of 3000mg/day is recommended for all adults of all sizes, men and women. That seems odd to me, seems like there should be some relationship to physical size - should a 220 pound male have the same dosage as a 120 pound female? My Neurologist has valid concerns over going too low on dosage to be effective, and the website drugs.com provides the following guidelines:
Dosing for Primary Generalized Tonic-Clonic Seizures
Adults 16 Years of Age and Older
Initiate treatment with a dose of 1000 mg/day, given as twice-daily dosing (500 mg twice daily). Increase dosage by 1000 mg/day every 2 weeks to the recommended daily dose of 3000 mg. The effectiveness of doses lower than 3000 mg/day has not been adequately studied.
Key phrase for me here is: The effectiveness of doses lower than 3000 mg / day have not been adequately studied.
At 3000mg / day I get severe dizziness, fatigue, sore throat, depression.
The issue I have is how do I find a dosage of Keppra that prevents seizures, but minimizes side effects so that I can get back to a semi-normal existence: drive, walk, hike, bike, rock climb. I am currently at 2500mg per day (I convinced my neurologist to allow me to go down 500mg per day after a month at 3000mg/day) I am still too dizzy to drive or bike or do much of anything. My Neurologist seems very concerned about going too low on the dosage (see quote above from drugs.com) which is understandable, but right now quality of life is pretty bad. How can we tell if I am at risk of having another seizure? EEG and regular MRI's after surgery were normal, they didn't predict the seizure. MRI after seizure didn't show anything abnormal either. So, how do I know if I can go down another 500mg or not? Will I ever get to a point where I don't need Keppra at all? Seems like there is no way to tell if I am going to have another seizure or not, but I really want to minimize these side-effects. Any suggestions would be greatly appreciated!