I am 44 yrs Indian male, with history of epilepsy since 1992, the latest episode on sep10 after 1999. There were about 8 episodes prior to that, the reason being initially without treatment and subsequently off medication for prolonged periods (The episodes were always while napping). The recurrence after a gap of 9 years was astonishing for me.

My medicine is phenytoin (Dilantin) - 200 mg at night adhered till sep10 since 1999 seizure, thereon increased to 300 mg on ad hoc basis

When the test results were available for blood sample of sep10, serum phenytoin was seen to be 7.01 mg/ml against therapeutic range of 10-20. (Otherwise I have normal EEG/CT/MRI brain scans)

On 4Apr08 MHC check I had abnormal Lipid studies of 5.2 TC/HDL ratio and high triglyceride(GPO) of 496 mg/DL, now corrected with atorvastatin (Storfib), diet and exercise. At the same time too the liver tests are summarised as Alkaline Phosphate-300 iu/l, Bilirubin total 0.5 mg/dl, SGOT(AST)-16 iu/l, Serum total protein-7.4 g/dl, Serum Albumin-4.7 g/dl, Serum Globulin-2.7, SGPT(ALT)-26 iu/l, and GGTP(IFCC)-109 iu/l.

GGTP of Apr08 is above reference range of 10-50: but has been dismissed away by 9 of 10 different specialists I consulted whereas my neurologist thinks it to be significant; putting me on 450 mg Udiliv (ursodesoxycholic acid), 250 mg Diamox (Acetazolamide), and 250 mg Becosules (VitaminB complex) from Sep11 (approx 1 month now).

Additional postulate is that drug phenytoin is the cause for elevated GGTP and she has advised a migration schedule for Lamitor OD (lamotrigine formulation). Incidentally, I just flipped thru the 9 yrs back GGTP study which was 120 iu/l then

Addl info: Aug8 tests indicated Alkaline Phosphate-203 iu/l, Bilirubin total 0.5 mg/dl, SGOT(AST)-39 iu/l, SGPT(ALT)-27 iu/l, and Serum cpk 203 iu/l. GGTP was not requested. The cardiologist I saw was happy with my controlled lipid profile and wanted me to repeat CPK at 3 months.

Because it is so difficult to talk to doctors or my doubts are too wild, I have some submissions.

1) What conclusions about the Liver can you make or what study may you advise me? With 1 month of Liver and vitamine tablets should I have a GGTP evaluation freshly done?
2) Is the epilepsy drug migration necessary and sufficient for the conditions I have described?
3) Any more details wanted please?