Seizure disorders lamotrigine

Absence seizures are best treated with ethosuximide, valproic acid, and perhaps lamotrigine. For a combination of absence and other generalized or partial seizures, valproic acid is preferred. If valproic acid is ineffective in treating a mixed seizure disorder that includes absence, ethosuximide should be used in combination with another AED. 

A rash, usually urticarial or maculopapular, is the most common event leading to early withdrawal of lamotrigine. In add-on trials, rashes occurred in up to 15% of patients and led to withdrawal in 2%. Six patients who developed a rash with lamotrigine later had similar rashes after exposure to structurally unrelated anticonvulsants, such as phenytoin and barbiturates (SEDA-22, 89). In 12 patients with probable Alzheimer s disease and seizures and 16 with other neurological disorders, lamotrigine caused three cases of mild rashes (43). 

Lennox-Gastaut syndrome is a mixed seizure disorder combining the atypical absence seizures with tonic, tonic-clonic, or myoclonic motor patterns. The syndrome begins in childhood and usually Includes mental retardation. Although adequate control of the seizures rarely Is achieved, valproate, phenytoin, felbamate, lamotrigine, topiramate, and clonazepam have been... 

Epilepsy is a clinical disorder characterized by spontaneous, recurrent seizures arising from excessive electrical activity in certain parts of the brain [51]. Currently available drugs, such as phenytoin, carbamazepine, valproic acid, lamotrigine, and topiramate (for molecular structures see Fig. 6), provide symptomatic seizure suppression in only 60-70% of those receiving treatment [52-54]. These drugs are also associated with unwanted side... 

Children Lamotrigine is indicated as adjunctive therapy for partial seizures in patients above 2 years of age and for the generalized seizures of Lennox-Gastaut syndrome. Safety and efficacy for other uses in patients younger than 16 years of age have not been established. Safety and efficacy in patients below the age of 18 years with bipolar disorder have not been established. 

A 19-year-old man with focal epilepsy took carbamazepine 1000 mg/day and lamotrigine 300 mg/day. Because his seizures persisted topiramate was added up to 200 mg/day and the dose of carbamazepine was reduced to 300 mg/day. Behavioral problems started within a week and worsened over the following months. He finally developed obsessive-compulsive disorder. Citalopram was given in doses up to 60 mg/ day and topiramate was tapered within 2 weeks. The symptoms improved. 

Irritability and aggressive behavior occur occasionally, and mentally retarded patients are possibly at greater risk (SEDA-22, 88). Rare central nervous system effects include insomnia, psychosis (SEDA-20, 63), downbeat nystagmus (SEDA-22, 89), movement disorders (SEDA-21, 72), and a Tourette-like syndrome. Lamotrigine can increase seizure frequency and severity in children with severe myoclonic epilepsy (SEDA-21, 72). 

Lamotrigine is useful for monotherapy and add-on therapy of partial and secondarily generalized tonic-clonic seizures in adults and Lennox-Gastaut syndrome in both children and adults. Lennox-Gastaut syndrome is a disorder of childhood characterized by multiple seizure types, mental retardation, and refractoriness to antiseizure medication. 

Lamotrigine is a 5-phenyl-1,2,4-triazine derivative indicated as monotherapy or as an adjunct for partiai seizures in aduits, as adjunct in patients with Lennox-Gastaut syndrome, and as adjunct for partiai seizures in chiidren 2 years of age and oider. Lamotrigine may have additionai benefit in combating myocionic and typicai absence seizures, it is approved for use in the maintenance treatment of bipoiar disorder. 

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