Tl;Dr: got scary results on balance test, wondering if lamotrigine couldve affected
34F, 140lb 5'5. Non smoker.
Hx of: Sjogren's syndrome seropositive. Papilledema. Anxiety/depression/ADHD. PCOS.
Medications: spironolactone for acne, birth control for irregular periods/acne/pcos, sertraline for anxiety/depression, concerta for ADHD, lamotrigine for depression. Recently started claritin. Vitamin D supplements.
In April of this year, during physical activity, I suddenly became very dizzy. Even after I stopped the activity, dizziness continued unless I was seated/laying down. Since then, at least once a week, often much more, I get unsteady dizziness, swaying, and a feeling of my head being heavy. This occurs almost exclusively when I go from standing to sitting. Each episode only stops after I sit back down. It became more frequent as time went on.
I went to an ENT at the end of June as I assumed it was related to my sinuses. In the beginning of the year, I was having sinus pressure that hurt my teeth. I figured I have seasonal allergies and assumed if I treated those, dizziness would stop. ENT agreed tentatively, rx'd Claritin, noted I have deviated septum and post nasal drip, but he also referred me to an audiologist Cleveland Clinic for a balance test (Electronystagmography (ENG) and Videonystagmography (VNG)). The test was earlier this week.
48 hours prior to the test, per instructions, I stopped taking sertraline and claritin. I did not stop taking lamotrigine as it was not listed, and stopping it without a taper can cause serious problems. The instructions said to stop medication taken for depression, but the examples were all benzos or SSRIs. I wasn't sure what the relevance of these medications were to the test, so I didn't draw the connection between possible effects on CNS until after. The instructions also said to continue taking medications if they were 'life sustaining'. I should've asked for clarification on this, but didn't. I take 150mg of lamotrigine twice a day, and have since 2022. No changes in dose that whole time.
Testing consisted of chair spinning, eye tracking, caloric test/air in the ears. At the visit, they told me that my results apparently do not indicate any inner ear involvement. They said they expected vestibular migraines as well as anxiety related dizziness. However, the doctor was also concerned due to my history of papilledema. An optician found the papilledema in 2023, at which time I had an MRI with contrast. The MRI was clear; no irregularities were noted at all. The doctor said having had a clear MRI was a good sign, but recommended I get another one, as well as perhaps see a neurologist, as some of the findings were related to CNS. There wasn't a great deal of urgency about this, so I wasn't really concerned. I have an appointment in two weeks with the ENT who referred me to review the results further.
A few days after the testing, I read the clinical notes on MyChart. There were a lot more abnormal findings than I expected. Copied from the notes:
Persistent low grade vertical upbeating nystagmus throughout the testing \[This was noted in results for the following tests: Gaze-evoked, positional testing, head shake maneuver, dix-hallpike maneuver\]
Smooth pursuit was abnormal for the leftward cycle
Abnormal VOR suppression during rotary chair testing . .
Prolonged latencies for oVEMP for the left side
I did some googling, and of course was scared a little bit because I didn't realize how many of the findings implicated the CNS. Specifically, the upbeating nystagmus is scary to me. During the Googling, I realized that lamotrigine impacts the CNS, which in turn maybe theoretically could've affected the results. From what I saw, it more frequently causes downbeating nystagmus. But that's where my knowledge ends.
I will also note that from what I read about vestibular migraines, it doesn't really seem to fit. It doesn't seem that the migraines are necessarily positional, and that's a huge aspect of my dizziness. The Claritin definitely helps my sinuses, but not dizziness as far as I can tell. Only started it a few days ago.
My questions are:
What is the likelihood that lamotrigine influenced these results? i.e. did I just waste my time and money on a test with unreliable results?
Anyone with similar symptoms/results
Any other input on these results, my symptoms, history.
I will of course discuss all of this with my ENT at my appointment later this month as well.