Husband's Post-Seizure Combativeness & Changes

Selena627

My husband was diagnosed with early on-set Alz last June 2020 at age 59. We were maintaining so-to-speak until this past June/July 2021 where suddenly noticed changes around bladder control, forgetting to wipe, communication was worse, and then early October he had a seizure. After the hospitalization and post-seizure he is MUCH worse. Added issues include not being able to tell when he needs #2 bathroom, and every single day he has anger outbursts multiple times per day, doesn't recognize us when this is happening. He has extreme anger and tells me, "I'm going to kill you." He's kicked his son, got into issues with trying to restrain him. There are episodes where he just snaps, nothing really triggers it. No one is speaking to him, or doing anything to cause it. Also post-seizure he doesn't know us more often. Wants to go home (not recognizing his own home), asks about his mother repeatedly who's been gone for 6 years. 

I'm working a full-time job still and trying to manage him. He is on Lexapro 15mg per day for "combativeness" but it's not really that great. Pre- seizure it did tend to work much better. In addition, we do have a prescript for something for agitation if needed twice per 24 hr day. Just wondering if these behaviors are common after this type seizure scenario. Is this indicative of any particular stage? Any advice or guidance? (interestingly the hospital neuro-psychologist after reviewing his test results from early on, strongly believes he has vascular dementia.)

Thanks for any thoughts, advice, guidance from others who may have experienced something similar. My thoughts go out to each and all struggling with this.

M1

Hi Selena, have you reported the anger and the threats of violence?  Just want you and your son to be safe.  He may need psychiatric admission to get those things under better control.  Please don't take any unnecessary risks.  There are a number of old threads addressing these things--never be without your phone, have a safe room where you can lock the door.  Others will respond too I'm sure.  Good luck, I know this is terrible.

MN Chickadee

My LO had a seizure in stage 6 of alzheimers, never had one before in her life. It did not make her combative. It set her back for a number of weeks, which makes sense, since the brain short circuiting like that is hard on them. Then long story short she was off her seizure med for a few days and had a second seizure. Same thing, she did rebound to her baseline after a number of days. Is he on a seizure prevention med? Is it possible there is a drug interaction with that new med another one he is taking? My mother took a good month for her body to adjust to the seizure med. She was lethargic and out of it for a few weeks after starting but eventually it improved. Also rule out UTI as they can often be otherwise silent and cause weird behavior in a PWD. Incontinence is expected with Alz in later stages, it sounds like maybe the stress on the brain from the seizure accelerated that aspect but it certainly isn't unusual to need help toileting and cleaning up and eventually most people end up in depends. 

I would see his prescribing physician, and if no other cause is found seek a geriatric psychiatrist. If he is aggressive he may need to go to an inpatient geri-psych unit for a few weeks, otherwise finding a psychiatrist to treat outpatient is in order. You can't let him continue on hurting people, it likely will not improve on its own and needs intervention. He could really hurt you or someone else.It happens.  For in-patient they stay at least a few weeks and are treated by doctors and nurses who specialize in behaviors associated with dementia and have special training for it, and once stable a person is released to go back home or a facility or wherever the family wants. Sometimes if a person is violent and the family can't coax them into going, they have to go the route of calling 911 during an episode. The person would be taken to the ER on a hold and from there could be transferred to the inpatient geriatric psych unit. It MUST be geri-psych. Regular ones are not equipped to deal with dementia, the ones dedicated to seniors are the only setting to deal with this. Lexapro is kind of a light duty drug when it comes to these behaviors, it's a basic SSRI that most people take for depression. It may take the edge off a mostly calm PWD but not likely to help with something this extreme.  Sometimes a PWD needs something stronger to control aggression and make care possible and improve quality of life. You need likely need pharmacological intervention, find either a neurologist or psychiatrist with experience with dementia. Good luck and let us know how things go. 

Selena627

Thank you! This is very helpful info. He is under a neurologist of whom said that things should taper off after a few days (that was after 3 weeks from the seizure). We are now a month in. Using Seroquel as well as Lexapro. Likely may need to adjust the dosage.  I have no long-term place for him to go, so it's not a lot of options for us. I will definitely explore the neuro-psych approach with this behavior, ask the questions and see if this is something to consider. 

Thank you for the time to share with me!

Selena627

Thank you for your reply and concern for safety! We have taken precautions. So far, he's threatened and hit with very little power behind it - however, I know that could change on a dime. My son is 19 years old - and very capable of restraining if the need arises. We are just mentally exhausted from dealing with it every day. Will be discussing more with doctors and maybe adjusting meds if needed. 

Thank you again for sharing your thoughts!

King Boo

I would strongly recommend that a Geriatric Psychiatrist who works with dementia become a part of your team.  This class of medications is their 'wheelhouse' and they often get the dosage/cocktails of medications correct where as PCP's and neurologists do not.