Lamotrigine valproate monotherapy

Biton V, Levisohn P, Hoyler S, Vuong A, Hammer AE. Lamotrigine versus valproate monotherapy-associated weight change in adolescents with epilepsy results from a post hoc analysis of a randomized, double-blind clinical trial. J Child Neurol 2003 18 133-9. 

Conversion from adjunctive therapy with valproate to monotherapy with lamotrigine Achieve a dosage of 200 mg/day of lamotrigine according the guidelines. While... 

Conversion from Adjunctive Therapy with Valproate to Monotherapy with Lamotrigine in Patients 16 Years of Age and Older ... 

Biton V, Mirza W, Montouris G, Vuong A, Hammer AE, Barrett PS. Weight change associated with valproate and lamotrigine monotherapy in patients with epilepsy. Neurology 2001 56(2) 172-7. 

Gidal BE, Tamura T, Hammer A, Vuong A. Blood homocysteine, folate and vitamin B12 concentrations in patients with epilepsy receiving lamotrigine or sodium valproate for initial monotherapy. Epilepsy Res 2005 64 161-6. 

In 126 patients with carbamazepine-resistant or valproate-resistant epilepsy given lamotrigine, 50% during add-on therapy and 53% during lamotrigine monotherapy had at least 50% reduction in total seizures (15). There were adverse events in 49 patients, including respiratory tract infections n — 11), dizziness (n — 8), headache (n = 7), diplopia (n = 5), tremor (n = 5), somnolence (n — 4), insomnia (n = 4), nausea (n — 4), and weakness (n = 3). Treatment was discontinued in nine patients because of adverse events, in five cases because of rash. 

The most common adverse effects of lamotrigine include dizziness, weakness, headache, diplopia, ataxia, blurred vision, and somnolence (SEDA-18, 65) (SEDA-20, 63) (19). These effects resemble those seen with carbamaze-pine and can result from an adverse pharmacodynamic interaction. Tolerability is better when lamotrigine is given as monotherapy or with drugs other than carbama-zepine however, tremor develops in some patients taking valproate in combinations (SEDA-18, 66). During monotherapy, serum lamotrigine concentrations associated with intolerable adverse effects (mostly headache, dizziness, and ataxia) were 0.4-18.5 qg/ml and overlapped widely with those tolerated in other patients (20). 

Jozwiak S, Terczynski A. Open study evaluating lamotrigine efficacy and safety in add-on treatment and consecutive monotherapy in patients with carbamazepine- or valproate-resistant epilepsy. Seizure 2000 9(7) 486-92. 

Clonazepam (Klonopin) was approved in 1975 for monotherapy or adjunctive treatment of akinetic (atonic), myoclonic, and absence variant seizures (64). Clonazepam also was found to be effective in controlling absence seizures, but because of the high incidence of side effects. It Is rated second to ethosuximide. It may be useful, however. In absence seizures when succinimide therapy has failed. It Is considered to be a third-line drug after 1) ethosuximide or valproate and 2) lamotrigine or valproate for the treatment of absence seizures. It is ineffective for treatment of generalized clonic-tonic seizures. 

In an open trial of monotherapy with car-bamazepine, phenytoin, valproate, or lamo-trigine in 505 Chinese patients with newly diagnosed epilepsy [3 ], 18% had adverse reactions carbamazepine (25/168 15%), phenytoin (18/59 31%), valproate (32/192 17%), and lamotrigine (16/86 19%). The... 

Zeng K, Wang X, Xi Z, Yan Y. Adverse effects of carbamazepine, phenytoin, valproate and lamotrigine monotherapy in epileptic adult Chinese patients. Clin Neurol Neurosurg 2010 112(4) 291-5. 

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