DEAR DOCTOR: I apologize for any errors that may have appeared, but your brief note is not very helpful in explaining how and where I went wrong, if indeed I did. Perhaps next time you want to tell someone he did wrong, you could elaborate just a bit.

For my readers, an epileptologist is a neurologist who specializes in epilepsy.

He takes synthroid, 175 mcg, once a day. I am wondering and have asked if there is a possibility of him having a reaction to this medication. It falls on deaf ears.

Last night, I called the ambulance, as he was having one of those spells again and could not walk. His speech and thought processes were slow. When the EMTs arrived, he seemed normal. Four hours of observation confirmed that everything was normal. This is not normal for him and never has been. I was questioned why I was wasting precious time calling an ambulance for something like this. I responded I am not a doctor and cannot diagnose what is happening. We have done everything the doctors have required and still want answers as to the cause. I feel they are treating the effects without checking into the possibility of it being a reaction to medication.

DEAR READER: Seizures are commonly brought on by sudden, abnormal electrical activity of the brain. Causes include head injury, drug overdose, brain tumor, accidental poisoning, low blood sugar or sudden lack of oxygen to the brain. They are divided primarily into two categories — focal or partial. Focal seizures occur on both sides of the brain, partial seizures on one side. They may present with muscle spasms, unusual sensations (such as your husband’s taste of burnt beef), loss of consciousness and more. In some cases, the cause is never identified, but the activity doesn’t necessarily represent epilepsy.

I would like to address your husband’s daily use of synthroid. When was he diagnosed as being hypothyroid? Is there a correlation between the time he went on the medication and the time the seizure activity began? The dosage is a rather strong one. Was he begun on a lower amount and increased over time? Has he been tested on a timely basis? The inert ingredients in synthroid include confectioners’ sugar, acacia, lactose monohydrate, magnesium stearate, povidone and talc. The dose also includes FD&C blue No. 1 Aluminum Lake and D&C red Nos. 27 and 30 Aluminum Lake dyes. Perhaps he is responding to the coloring. Were he on a lesser dose, the dyes would vary in intensity.

If he had a CT scan to rule out a brain tumor, didn’t sustain a head injury within the past month or so, hasn’t been accidentally poisoned, and can’t attribute the activity to a recent occurrence, perhaps the medication is the cause of the seizure activity.

I recommend he ask his physician for a little indulgence. If the medication isn’t vital, perhaps they can compromise on a trial without it. He might consider diet modification — include cabbage, Brussels sprouts, lima beans, broccoli, cauliflower, potatoes, bananas, and supplemental vitamins B and C. Fats, sugars, red meats and eggs should be consumed in moderation. And he should exercise 15 to 20 minutes every day unless his doctor says otherwise.

If no improvement is found, request a referral to a new neurologist for a second opinion.

To provide related information, I am sending you a copy of my Health Report “Thyroid Disorders.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

I read your column every day, and you have helped so many people. I hope you have an answer to this puzzling physical problem. Thank you.

DEAR READER: There are a number of medical conditions I considered when first reading your letter. The first was Tourette’s syndrome. This was easy to rule out, however, because diagnosis, in part, is confirmed in the presence of both motor and vocal tics that can but don’t necessarily occur at the same time. Then I put on my thinking cap and realized your friend is likely suffering from seizure activity. I will explain why. Seizures are an indication of a brain problem, but not all seizures cause convulsions and unconsciousness. For example, focal or partial seizures occur in just one part of the brain, as opposed to generalized seizures, which affect both sides. They can be brought on by abnormal heart rhythms, brain damage or infection, high fever, metabolic disorders and a great deal more.

And now the interesting part: A Jacksonian seizure falls into the “partial seizure” category. It affects one part of the body and will then spread to another. Movements may occur in the hand or foot, moving from that limb onward as the electrical activity spreads to the brain. A person will be completely aware of what is happening during the abnormal activity.

I recommend your friend make an appointment with her primary-care physician or a neurologist. Simple lab testing and an EKG can rule out a number of possibilities. An electroencephalogram (EEG), MRI or CT scan might be appropriate for confirmation of diagnosis. If she is found to have a seizure disorder, one could occur at an inopportune time and cause injury to her or others. This should be avoided at all cost. There are a great number of prescription medications available for control. As a friend, express your concerns and suggest she seek assistance.

To provide related information, I am sending you a copy of my Health Report “Medical Specialists.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

Blood tests and the cost of my medications are beyond what we can afford. I tried several avenues of contacting drug insurance companies and with the Montel Williams Program, but was turned down.

Do you have any suggestions on how to afford the only effective treatment I have found? Naturally, seizures are often stress-related and this is causing me great stress.

DEAR READER:
You are certainly in a predicament. Your local neurologist has concocted the only solution that works.

You are on a combination of three anti-seizure medications that are manufactured by different pharmaceutical companies. Specifically, Keppra is from UCB, Inc., Carbatrol ER is from Shire US, Inc. and Felbatol is from Medpoint Pharmaceuticals. Perhaps this is the basis from which to start. Can your prescribing neurologist write a letter of medical necessity that you or he can forward to all three companies to determine if they have any provisions for people in your situation? I am sure you are aware that many pharmaceutical companies have programs for people without insurance or funds to pay for needed medications. Perhaps the three can formulate a plan that will fit your needs and your pocketbook.

I would also suggest you tap in to the Epilepsy Foundation that has facilities in many states. You might begin with the Epilepsy Foundation of America, 8301 Professional Place, Landover, MD 20785, www.epilepsyfoundation.org or you might phone 1-800-332-1000. Once you get a name and local facility, some doors might open. Good luck in your endeavor.

We’ve said a few things to his wife, but don’t want to discuss it too much with her any more because she’s a hypochondriac. She just goes to church, falls down and says the Lord has healed her. She is no help in this situation, even though she’s 10 years younger than our brother.

Do you have any suggestions on how we can help him without alienating them both? Could his problem be early stage Alzheimer’s, medications or just aging? He has diabetes, consults several herbalists and takes herbs that we think are questionable and unnecessary.

I know this isn’t giving you enough information but our main concern is the blank looks like he’s gone from us for a few seconds and then snaps back like nothing happened. Any information you can give us will be greatly appreciated.

DEAR READER: Your brother needs a diagnosis from his primary care physician who should have a complete record of his medical history. I would recommend your brother be referred to a neurologist as the next step.

While you mention diabetes and medications, you don’t indicate if he is on something for his diabetes or if there are other conditions that might have a bearing.

If he were on more than one medication, the combination might have an adverse effect and present with periods of confusion.

He is 75 and could have early stage dementia, Alzheimer’s disease, epilepsy (or similar seizure disorder) or others. Dementia is a deterioration of a mental state with a variety of causes. Some herbs can cause dementia-like symptoms. Epilepsy may consist only of a fleeting loss of consciousness, rather than seizure activity. Lacking other symptoms, I believe Parkinson’s can be ruled out. As you can see, a diagnosis must be made.

Because of Health Insurance Portability and Accountability Act (HIPAA) rules, you probably will not be able to discuss this with your brother’s physician (you can write a letter of concern and report his symptoms, etc., however). Therefore, I suggest you both get your sister-in-law off the floor, in a good frame of mind and express your concerns. Perhaps you can then accompany your brother to his next doctor’s visit where you can speak freely with his physician. I am sure he will ultimately appreciate the caring position you’ve taken.

To give you related information, I am sending you a copy of my Health Report “Alzheimer’s Disease”. Other readers who would like a copy should send a self-addressed, stamped, number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Our family physician retired and our new (young) family physician said the decision was ours, but we should think about stopping the medication. We’re hesitant because we dread the possibility of seizures again. What are your views on this situation?

DEAR READER:
Most neurologists I know often remove patients from Dilantin if they have been seizure-free for several years. This must be done by gradually reducing the dose and must be supervised by a neurologist. Only this type of specialist can tell you if it is appropriate to discontinue the Dilantin.

You and your son need to speak to his neurologist about the possibility of stopping the medication, the possible risks and benefits of stopping versus continuing and whether your son is indeed a good candidate for removal of the Dilantin.

If the specialist believes it is best to stop the medication, he or she may recommend testing before, during and/or after the process. This will provide appropriate monitoring of your son for any adverse effects from stopping the Dilantin, such as return of the seizures or abnormal brain function.

I am not a neurologist and am not familiar with your son’s case. His neurologist is his best source for further information.