How to lower my seizures with epilepsy and hypothyroid at 28?

Question

Hi doctor,

I am a 28-year-old female, and I have been living with epilepsy since I was 16. I usually get generalized tonic–clonic seizures, and despite being on Levetiracetam 1000 mg twice daily, I still had three episodes in the last six months.

My last EEG showed abnormal epileptiform discharges in the temporal region, and my MRI brain showed mild hippocampal sclerosis.

Along with epilepsy, I was diagnosed with hypothyroidism three years ago, and I am taking Thyroxine 75 mcg daily. My recent TSH was 6.8 mIU/L, which my doctor said is still above the target range. I also feel very tired, gain weight easily, and have trouble concentrating after my seizures.

My weight is 171 pounds and height is 160 cm, so my BMI is 30.4, which puts me in the obese range. I also had low vitamin D levels, 17 ng/mL on my last blood test, and I read that vitamin D deficiency can make bone health worse, especially with long-term anti-seizure medications.

My hemoglobin was 10.9 g/dL, showing mild anemia, and I sometimes feel dizzy or short of breath on exertion. My seizures often get triggered when I do not sleep well, and recently, my work stress has been high. I am worried that my uncontrolled thyroid and anemia are making my seizures harder to control.

Is there a need to adjust my seizure medicines, or should the thyroid dose be corrected first? Also, can obesity and vitamin D deficiency increase my seizure risk or medication side effects? I want to know what else I can do to reduce seizure frequency and improve my energy levels, as this condition is affecting both my work and personal life.

Please advise.

Answer 1

Hi,

Welcome to icliniq.com

I read through your history carefully, and I understand how frustrating it must be to deal with epilepsy, thyroid problems, weight issues, and tiredness all at the same time. Let me break this down for you.

You have generalized tonic-clonic seizures, and your electroencephalogram (EEG) and magnetic resonance imaging (MRI) show temporal lobe changes with hippocampal sclerosis. Even though you are on Levetiracetam 1000 mg twice daily, you are still having seizures, which means your epilepsy is not fully controlled, and this may need re-adjustment of medicines or adding another drug.

Your thyroid is still underactive, as your thyroid-stimulating hormone (TSH) is above the target range. This can make you feel tired, gain weight, and also interfere with seizure control. Optimizing your Thyroxine dose is very important.

Your vitamin D is quite low, and you also have mild anemia. Both of these can worsen fatigue and affect bone health, especially with long-term seizure medications, and may even play a role in your overall seizure threshold.

Your BMI is in the obese range, and obesity can also add to tiredness, poor sleep, and low energy. Poor sleep and stress are well-known triggers for seizures in people with epilepsy.

In short, your seizures are being influenced not only by the epilepsy itself but also by your thyroid, anemia, vitamin D deficiency, and weight. The right approach will be to adjust your thyroid dose, correct the deficiencies, and then also reassess your seizure medicines.

I hope this helps answer your query.

Thank you.