instruction: hi doctor I have been diagnosed with temporal lobe epilepsy following a tonic clonic seizure before nine years from then before two years I was seizure free having been put on lamotrigine before two years I had another to seizure and my dosage was raised cannot remember the dose precisely and I was seizure free for almost a year when I had another to seizure at this point my dosage was raised again to 125 my twice a day despite this I have had a number of absence seizures this seizure was followed by a 24 36 hour period of not just extreme tiredness but very strange mental sensations including what felt like a rush of intelligence as well as frequently repeating thoughts and unexplainable strange thoughts not distressing more like feelings of another time as well as what I guess are best defined as nonsense thought trains about advanced concepts such as genetics or psychology following this I had an mri which reported nothing abnormal say for a small number of tiny foi of to hyper intensity within the all white matter of both hemispheres non specific the areas of the left frontal lobe where there has been previous eg evidence of epileptogenic focus were normal all of the above paragraphs is directly quoted from the radiologist letter to my go since then I have had two absence seizures with similar post seizure symptoms my lamotrigine dosage has increased to 200 my twice a day now I am having regular nocturnal seizures two to four weeks which leave me similarly confused and with the same weird thought patterns I had one about three days ago where these symptoms were particularly acute and have worried me greatly in all cases I recovered quickly and found sleep to be a major contributing factor to my recovery now just over 48 hours since my last seizure these symptoms have again subsided they have occasionally appeared prior to seizures making me think they are auras but they do not seem to be anything like the aura descriptions I have read about during a recent appointment with a clinical nurse I was put on a new prescription of brivaracetam ex 25 my alongside the current lamotrigine dose I have yet to begin this the fact that there is a little reference online to these symptoms is quite distressing to me particularly given how bizarre they are these potentially a result of the point of epileptogenic focus might they be a reaction to the lamotrigine my current medications are fluoxetine 40 my per day atorvastatin 40 my per day metformin 100 my 10 units insulin glargine lamotrigine ex 200 my brivaracetam ex 25 my yet to commence
output: hi as per the given information I can understand that these symptoms are the effects of seizure and unlikely to be due to lamotrigine the primary goal of the therapy is to control seizure episodes for which you have been prescribed brivaracetam you must start the new medicine along with the old one with which the symptoms must go mri magnetic resonance imaging scan may not reveal epileptogenic focus other than hippocampal sclerosis and some volume loss the best way to find epileptogenic focus would be eg electroencephalogram if possible can be done later if seizures are not controlled with the prescribed medicines