A Weird Seizure Drug

It's not a change in volume but a change in pitch?

Correct, it's change in pitch. There's no problems with his ears either, it started with taking the drug.

http://scitation.aip.org/getabs/servlet/GetabsServlet?prog=normal&id=JA… for example. Well. That's kind of cool.

You might try mentioning this at Retrospectacle -- she's a neuroscientist with expertise in the auditory system.

Oliver Sacks, a neurologist and author, covers phenomenon such as this in his new book, "Musicophilia." I highly recommend it to both you and your friend.

From the Wikipedia entry on Carbamazepine, aka Tegretol:

"There are also reports of an auditory side effect for carbamazepine use, whereby patients perceive sounds about a semitone lower than their actual pitch. Thus, middle C would be heard as the note B3 just below it, etc. This unusual side-effect is usually not noticed by most people, and quickly disappears after the the person stops taking carbamazepine."

Crazy.

Someone has a single event and they prescribe serious seizure drugs? That seems over-reactive. It could have been a complex-partial seizure, but it also could have been skipping breakfast.

(Doing IT for a poison center and pharmacy college lets you access some interesting databases :-)

Micromedex gives the generic name as Carbemapazine,, and the listed side effects do not include auditory effects.

Side effects:
Common
Cardiovascular: Hypertension, Hypotension, Lightheadedness
Dermatologic: Erythematous condition, Photosensitivity, Pruritic rash, Urticaria
Gastrointestinal: Nausea, Vomiting
Neurologic: Clumsiness, Confusion, Dizziness, Nystagmus, Somnolence
Ophthalmic: Blurred vision, Diplopia

Serious
Cardiovascular: Atrioventricular block, Cardiac dysrhythmia, Congestive heart failure, Syncope
Dermatologic: Stevens-Johnson syndrome, Toxic epidermal necrolysis
Endocrine metabolic: Hypocalcemia, Hyponatremia (4% to 21.7% ), Syndrome of inappropriate antidiuretic hormone secretion
Hematologic: Acute intermittent porphyria, Agranulocytosis, Aplastic anemia, Bone marrow depression, Drug-induced eosinophilia, Leukocytosis, Leukopenia, Pancytopenia, Thrombocytopenia
Hepatic: Hepatitis
Immunologic: Systemic lupus erythematosus, Aggravation
Renal: Acute renal failure, Nephrotoxicity
Other: Angioedema

Your friends auditory issues could be related to whatever caused the siezure.

Same thing happened to me after I had a bad clonic tonic seizure (I am epileptic). I was also on Tegretol. Anyway, either my hearing got better or I compensated for it, because it went away after awhile.

Tegretol had other weird side effects for me, as well, including making my tongue numb. Incidentally, I'm on Lamictal now and it's much better.

Er. Tonic clonic. Dur.

Writing my final paper... brain is moosh.

I was on Tegretol for a short period of time (only a week) over a decade ago. Not long enough to notice any auditory issues, but it Did Not Work For Me (TM)...I tried to do silly things like chase after the pretty lights of cars. I think my doctor of the time jacked me up to full dosage way too quickly.

I've been on Gabitril for a long time (since the study, for that matter), which is much better for me. Hope things work out for your friend.

I've been on Tegretol for many, many years and never had that particular problem... but then, I don't have much of an ear either. At first it really killed my balance, and my short-term memory. I wonder if these side effects are related to where the source of the seizure is?

Diisopropyltryptamine has been reported to have some pretty strange auditory effects. Unlike in your friend's case, where pitches are being proportionately reduced, thus preserving harmonic and melodic relationships, diipt seems to reduce the perceived frequency of pitches by the same number of hertz regardless of frequency. This must create some bizarre effects. Other reported effects are tinnitus and a sensation of pressure in the inner ear. Sounds like fun.

Forgive me, but rant I must.

Tegretol is an example of a drug that is ancient and therefore cheap.

It has always been associated with a lot of neurological side effects, including confusion and somnolence. Before there were better alternatives, many patients lived life in a Tegretol-induced simulacrum, never realizing how zonked out they were until they switched to a newer agent.

Tegretol is certainly no safer than modern alternatives. So, why is it prescribed at all?

Because it is generic and inexpensive!

Physicians - especially GP/FP's - will prescribe the cheapest drug available and then wait for complaints from patients before they switch them to something better.

This drives me crazy. Doctors are prescribing according to what is in the best interest of insurance providers instead of what is in the best interest of their patients.

Most folks pay good money for prescription coverage. They deserve better drugs than what they are initially "allowed" to take from their insurance robots, sorry, physicians.

Rant over.

Perhaps it is not the Tegretol but the seizure itself which is causing the auditory phenomenon.

Coincidentally, NPR had a very interesting program this morning about a woman who suffered from "musical epilepsy".

"One night, back in the 1970s while sleeping in her room at the Catholic old people's home in the Bronx, she was awakened by a voice, a female voice singing Irish ballads."

http://www.npr.org/templates/story/story.php?storyId=17261330

The only side effect I remember from tegretol when I was prescribed it as a child (for ADHD, if anyone's curious) was having some freaky experiences in which I felt like my heart had just stopped and my body was drained of blood. Scary as hell the first time it happened, which coincidentally came just as I cut a prayer short because I wanted to listen to a song and I was rambling anyway (as much as one can make such judgments about conversations with imaginary beings, anyway). I thought God was punishing me. Anyway, we saw the doctor about it, and he explained it was just a side effect, so after that it was just a weird little event I would occasionally have and shrug off afterwards. Other than that, I don't remember anything else about it.

Article on such effects here:

http://www.pedneur.com/article/PIIS0887899406000828/abstract
(Free registration required, etc etc)

http://scienceblogs.com/retrospectacle/2007/12/auditory_side_effects_of…

All that said, anyone on Tegretol who intends to go off it should consult their doctor first. Just as dosage may be gradually increased when starting the drug, dosage may be gradually decreased when stopping it. Quitting "cold turkey", full dosage to zero in one day, may not always be a good idea. Each person's situation (and full dosage) may vary.

Not a doctor, not pretending to be, just urging consulting a doctor.

Once again you materialist science types are blinded by your naturalistic assumptions.
A half-octave is a tritone. The tritone used to be known as "the Devil in music" because of its dissonance. (Dope-smoking fornicating bebop musicians in the 1940s used it a lot, disguising its satanic origin by calling it a "flatted fifth.")
Clearly this powerful drug has opened some sort of evil psychic portal and caused this poor young man to be POSSESSED by DEMONS or WORSE!!!!!11!!!!
Call an exorcist, stat!

As a child, I was on tegretol for several years. Being that I was young, I don't know that I would have noticed that kind of unusual side effect. However, I can say that this is a bad time for a student to be going on the stuff. It made me very lethargic the first few weeks I was taking it. Buy your friend some good coffee as an early Squidmas present!

Does the friend have absolute pitch? I imagine it would be easier to adjust to (and harder to notice) the side effect without it.

I'm also curious about the "half-octave" interval - how was it measured? A fourth and a fifth are roughly half an octave and are both perfect intervals (the opposite of a tritone, which is exactly a half-octave), so they have fundamental acoustical properties that might imply something about the mechanism. The Wikipedia article describes a shift of only a semitone, which wouldn't be consistent with that kind of hypothesis.

Gingerbaker: Same deal with phenobarbital. They are still prescribing that garbage for some people (and little kids!) because it is "safe". You're right about the cost, though. Phenobarb and Tegretol are a lot cheaper than Lamictal (what I take)... a month's supply of my stuff costs over $1000. I'm glad the insurance company covers it... my copay is just $15.

In my link above, I dicuss what has been reported in the literature about this side effect. One, its quite rare for people to notice it, and is usually noticed by people who were musicians and had absolute pitch before the administration of the drug. Only a few dozen case studies have been noted, but the effect is always the same, a change in pitch of about a semitone lower than it ought to be.

This is a perception problem, and is not related to the seizures or suggests any damage to the inner ear or auditory cortex. This drug reduces seizures by stabilizing voltage-gated sodium channels in the brain, making them less likely to engage in an action potential. Of course, the voltage-gated channels in the auditory cortex are also affected and may alter the way that it is able to respond to, and process incoming sound stimuli. Most people wouldn't notice the change, although people with acute pitch perception would.

There are other anti-convulsants which do not have this side effect. Talking to his doctor about the symptoms and about changing drugs would be a good idea.

I was on Tegretol for a few months but never noticed that... but I wouldn't have anyway, because I already had that problem in one ear.

Ever since I got Meniere's Disease, I've had serious distortion in pitch in my left ear. If I plug my right ear and listen only with my left ear, what's left of what I can hear (since most of the hearing is gone) makes everyone speaking sound like they had inhaled helium.

I've tried explaining this to people and they don't seem to get it. Even my ear doctors pay no attention to me when I tell them this... so in hearing tests, if I can hear the "beep" in the ear, then they mark it down that my hearing is unaffected in that range, even though the beep may actually sound three octaves higher, and sound more like a buzz than a beep.

Having worked with children and young adults with seizures (and behavioral issues) for well over a decade, one thing I've learned is that seizure medication response is highly idiosyncratic. A lot of tinkering is often necessary to find what works best for a person's "reason for having seizures." Phenebarb and Tegretol are often effective and used frequently because they work well to control seizure activity. Side effects are common and further tinkering occurs to find the best regimen for a person. That's assuming the neurologist is responsive to feedback. The friend should report the side effect to the prescribing physician and ask for advice.

I've been on Tegretol (carbamazapine) for many years. The only notable side-effect I've experienced is very vivid dreams for a short while, maybe a week, after starting on it, and also for a short while after changing generic brands. The vivid dream thing was totally cool, a real "trip", I wish it hadn't worn off! The only unpleasant experience with the drug is that if one ODs a bit, 200-400mg over normal dosage say, it results in a very spaced-out, hung over feeling. Unpleasant but not incapacitating. I've never noticed any auditory issues.

There's a big difference between a semitone (reported side effect) and what your friend is experiencing.

My daughter was initially prescribed tegretol, and it was effective but the neurologist didn't want to keep her using it for too many years. She was only 3ya when she first started experiencing her partial-complex seizures, and he didn't think that the data were satisfactory regarding pediatric mental development and he didn't to take the chance of it slowing her faculties. She never reported any side effects like those described above.

He switched her to lamictal and the shit is pricey, for her dosage it is $425 for a thirty day supply. Generics aren't satisfactory because variances in dosage teeter between ineffectiveness and dangerous side effects. We discovered that when she started menstruating, lamictal was basically ineffective. She ended up having a partial rescission of her right frontal lobe and has been seizure-free now for three years (although she still remains on lamictal.)

Random thought, but maybe the half-octave thing was the result of a miscommunication, and what was originally said was "half-step" (aka a semitone). I've never heard anyone describe a tritone (or any interval) as a half-octave.

I look after a friend with severe epilepsy who takes Tegretol amongst several anti-seizure compounds. The drug that had the surpising side-effect for Chris was Clobozam, which for the first year or so would regularly disable his spatial vision and judgement. We called them 2-D Attacks, and they were pretty dangerous, especially outdoors. He had two very near encounters with cars, as he was unable to judge if they were close or far away. The effect for him was different from, say, if he just closed one eye. His spatial reasoning was impaired, too.

Fortunately he is now acclimatised, and the episodes have stopped. He says Tegretol is really rough old stuff. It makes him feel pretty sick sometimes.

I was on Tegretol for nearly 20 years until my Doc switched me to Lamictal. I was in choir in high school and was often told I was off pitch. I never imagined it to be the Tegretol because I had been on it since I was 6 years old, so everything sounded normal to me. It makes me wonder now if that had been the cause of my being off pitch. Whatever it is that your fried has that is seizure related, I suggest getting him off Tegretol right away and getting him onto something else right away.

Tonic clonic. Dur.

Or, if you were suffering from the auditory problem in question, sub-dominant clonic.

Bob

I've been trying various anti-seizure medications since I had brain surgery a couple years back (Aneurysm caused by AVM).
It's a good thing I took an IT job at a University with a world-class hospital. I've got a great Neurologist who's on top of my case. Luckily I also had an authority on AVMs who was also a fantastic surgeon for my AVM removal. I have almost no scarring in my MRIs but I still had a couple of post-op seizures. I suspect those were mostly due to dehydration, mild alcohol consumption in one case, and a general lack of sleep.. oh yea, and going off my meds without telling my doc in the other case. ;-)

I'm coming off Tegretol right now. I did notice the vivid dreams which someone mentioned. I thought that was cool. I had a pretty vivid one this morning.
I also pretty much lost my short term memory. All anti-seizure meds seem to have this problem though. They depress your brain to prevent the uncontrolled firing that is a seizure. I've also been legarthic and a bit depressed in a non-specific way. I put on 5lbs between Drs visits. :-(

For the person who said Tegretol is only used for price, it's not all that cheap. I don't know what full price is but I pay $33 co-pay for 120 tabs (two months). I've got pretty good insurance too, my brain surgery cost me exactly a $10 co-pay.
My doc didn't give me tegretol just because of price. It was my 3rd med after I complained of sluggishness and memory issues (like completely losing words) on Keppra and that other one.. forget the name. It was prescribed because it had less side affects than other drugs.

I'm transferring to Lamictal now. It's not supposed to be as depressive as Tegretol. Apparently some users claim it's a very mild stimulant but I think that's a somewhat rare side effect. I can't believe it's as expensive as mentioned here though, that's just ridiculous. I'm on a free 'starter pack'. It's kind of like giving kids their first 'taste' of crack for free apparently. Get us on it for free.. then you get hit with the bill later.

It does have an interesting side affect though. Some people get very serious rashes that will progress to lesions and move from skin to mucus membranes (including lung lining!). I'm on rash watch now.

The bottom line is, all anti-seizure medications suck. They all have a litany of side affects. The most common are what you would expect, they depress you and do weird stuff to your mind because they're messing with your brain's bio-chemistry.
If I didn't drive.. and if I repeated didn't damage your brain I'd just skip the meds and deal with rare seizures. At least a good seizure is undoubtedly the best workout you can get in 5 minutes. :-) I'd be in fantastic shape if I could arrange for 3 or 4 a week. :-P

http://www.ingentaconnect.com/search/article?title=A+rare+side-effect+o…

According to the above abstract, the shift in pitch perception is quite rare - full text is currently not available so I'm not sure if they host the entire article for free.

How do we know his hearing isn't a tritone too high and this medicine is restoring it to normal?

[blockquote]It does have an interesting side affect though. Some people get very serious rashes that will progress to lesions and move from skin to mucus membranes (including lung lining!). I'm on rash watch now.[/blockquote]

YES, I had that! Well, started to. I was switched to Lamictal (from Tegretol) by my general practitioner before I had a chance to see my neuro (who is always booked for months at a time as he is the only certified epileptologist in the vicinity). The problem was that the initial dosage was MUCH too high, and I developed a bad rash. It started on my chest and spread up my neck to my face, and my nodes became painfully swollen. I ended up at urgent care and we figured out it was the Lamictal... went off of it for a couple of days and the rash instantly cleared up. I'm glad it didn't get to the point where my skin started falling off...

But you're absolutely right, all seizure meds suck. It's maybe worse for me because there is no known cause for my seizures. Nothing has ever shown up on MRI or EEG, which means we treat it by trying different things and saying, "Well, um, it SEEMS to work!" Course I'll never know for sure unless I have another big seizure. Haven't had a grand mal for almost four years, but I have small focal seizures ("auras") every day. I'm just lucky, I guess! :P

Man. I just had my butt handed to me by HTML. I'll get you next time, Gadget! *shaking fist*

My Stepson was on Tegretol for several months about 14 years ago. He already had a hearing problem and while on Tegretol he had great difficulty understanding speech and suffered from auditory hallucinations. He also had to quit playing the trumpet as he couldn't hear when he was on pitch anymore.

We switched doctors and the first thing they did was take him off the drug. It turns out he was misdiagnosed and didn't need a seizure medication anyway. However, he lost all interest in playing music and has little interest in even listening to it today.

This might be what you want:

Half Pitch Lower Sound Perception Caused by Carbamazepine

http://www.journalarchive.jst.go.jp/english/jnlabstract_en.php?cdjourna…

or

http://tinyurl.com/2xxzm3

Tegretol has a host of unwanted effects; most anti-seizure meds do. I take Topamax, one of the newer choices, (after trying almost all of the other a-s drugs) for trigeminal neuralgia because it works well and has fewer nasties than the other ones. However, I still put up with some drug induced fatigue, often have trouble retrieving words, and some memory problems.

The older anti-seizure drugs do work very well for many people. It is my impression that problems are frequently dose related.

There have been many studies on the effects of marijuana to help control seizures and I know someone who finally turned to that because he could not tolerate the meds. The worst side effects he had were a brief period of the giggles and the craving for peanut butter and fruit loop sandwiches.

Has anyone heard of something similar?

My 3 year old was just diagnosed w/ partial complex seizuers.He has been on tegretol for 2 week now, have noticed some clumbsyness,but none of the other side effects yet.Or mabey he has and just dosn't have the vocab to say so.I am a very worried mom, diddnt even want to start the drug kept putting it off.This is all new to me.Im am worried about his learning right now this is a very crusial learning time.Wondering how I will know if it is effecting his memory.If anyone has any advice PLASE COMENT!