January 7, 2010 back to neurologist for 2 blood draws

On January 7th Brady and I went to Yorktown for another visit with Dr. Katherman. I was very happy to report to her that Brady had not had any further seizure activity and that after about 2 weeks of being on the Zonisamide we were beginning to see improvement with the ataxia. There was still some slight uncoordination from time to time but nothing compared to the way it was. He was there to have a Zonisamide peak and trough blood draw. A blood sample was taken at 10am and another one was taken at 12 noon.

Peak and trough are methods used to establish the effectiveness of a drug. Peak is drawing the serum blood levels after the drug is administered as it distributes rapidly and reaches its peak in therapeutic range.
Trough is drawing the serum blood levels right before the next dose. Trough is the lowest drug level that is needed to reach therapeutic range. If trough is > than normal, the patient is at risk for adverse effects. Therefore, the doctor should expand the time interval before ordering the next dose or decrease drug dose.

In general, a trough is usually drawn one hour prior to start infusion and the peak about one hour after the infusion finished.

Our little drunk sailor

I spoke with Dr. Katherman on Friday December 18 about Brady's continued wobbliness and unsteadiness. The ataxia that he was experiencing can be a side affect of both Potassium Bromide and Zonisamide, but the hope is that this side affect will subside with time. The definition of ataxia is loss of coordination of the muscles. Her advice was to divide his Potassium Bromide (600mg) dose into three 200mg doses per day instead of giving him 600mg all at once. In order to do this I would have to change him over to the liquid form since he was on one 600mg capsule that couldn't be split. As it turns out the liquid form is less expensive than the capsule form. Either way, Potassium Bromide has to be compounded by a compounding pharmacy. Not all pharmacies compound, something I was not aware of before.

The day after Brady's appointment with the neurologist

On December 16th Dr. Katherman called to get a progress report on Brady. I let her know that thankfully there had been no seizures. However, Brady was terribly unstable on his feet, very wobbly and uncoordinated. We were calling him our little drunk sailor. She said it could be the result from all of the seizure activity that he had experienced or it could be the side effects from starting the Zonisamide. Or it could very well be a combination of both things. Her advice was to give him some time and hopefully we would see improvement.

She also had the results of his liver function test that was done the day before and the wonderful, fantastic news was that his liver is functioning normally. That is an incredible blessing because all the years he's been on phenobarbital, only liver enzymes were checked never liver function. Dr. Katherman told us that checking the liver enzymes don't give any information about how the liver is functioning and only a liver function--urine bile acids test will reveal how the liver is actually working. It is a great relief to know that Brady's liver is functioning normally. It will be very important to have this test done periodically since phenobarbital can cause liver damage.