Q. My daughter is appx 1 yr. out of a brain injury involving her R. temporal lobe which resulted in a small wedge removal because of swelling. She was completely seizure-free until last month when she jumped into a cold creek from appx 20-30ft. She had three seizures appx. 2-3 hrs. later. Now she is on 200mg Dilantin daily. I have read conflicting articles on whether Dilatin causes memory loss , some say it actually improves memory. Also, she smokes, appx 1/2pk cigarettes daily and I was wondering about any effects that might have on her with the Dilantin that she takes and also what it might entail neurologically with her improvement. She is weaning herself off the cigarettes gradually and intends to quit next week. I have also read conflicting reports of the effects of nicotine on the brain. Please give me your opinion on these matters and it will be greatly appreciated.

A. Dilantin can cause some folks to have memory problems. This is usually not a huge amount of memory loss, however. What frequently happens is that it slows down their thinking a bit, so they do not feel as sharp. Overall, the data would favor using it in a seizure patient as opposed to giving nothing if seizures are present.

Alternative agents like Lamictal, Tegretol, Neurontin, Depakote, and others are available. Not all of them are appropriate (consult with her neurologist), but they may cause less of a problem with memory in her particular case.