instruction: hello doctor since after the holidays last year I have had a hard time sleeping due to some external factors light noise etc as well as marital problems eventually it got to the point where my hands started shaking again I stated feeling numbness in my feet my eyes move very fast sometimes these are all symptoms I experienced when I was taking phenobarbital and phenytoin four years back my neurologist changed the phenobarbital with levetiracetam and together with phenytoin the combination worked very well until I started experiencing these symptoms due to the lack of sleep also a weird sensation that I had at one point I felt as if my brain was growing bigger and bigger inside the skull and it got to the point where I was experiencing pressure and eventually headache after almost six months of lacking sleep I feel as when I was taking phenobarbital and phenytoin I have problems getting an erection I lack the energy I feel sleepy throughout the day and I experience all the symptoms which I only experienced with phenobarbital I really want to get back to how I felt when I started the treatment with levetiracetam are there medications that could replace both levetiracetam and phenytoin or maybe just the phenytoin could the phenytoin be taken out of the treatment completely please help me
output: hello I would like to know some details of your symptoms since when you started to have epilepsy when you started to take anti epileptic medicines seizure details what happens during a seizure to you do you get aware of seizure just before it starts how frequent are seizures how many times in a month or year before starting anti epileptics while taking phenytoin while taking phenytoin levetiracetam since when you started to feel lack of sleep weird sensations lack of energy what other symptoms you feel these days how is your mood in day today activities appetite do you have ever undergone mri brain and eg and other blood tests if yes please send the reports and mri films through dicom software from mri cd how many times in a day you taking tablet levetiracetam 500 my phenytoin 100 my