Seizures lamotrigine

Studies suggest that as monotherapy for partial seizures, lamotrigine is as effective as carbamazepine and phenytoin lamotrigine may be better tolerated. Clinical data suggest that oxcarbazepine is as effective as phenytoin, valproic acid, and immediate-release carbamazepine, with perhaps fewer side effects. 

Myoclonic seizures consist of sudden, very brief, jerking contractions that may involve the entire body or be confined to limited areas, such as the face and neck. The contractions may affect Individual muscles or groups, with simultaneous contraction of both extensor and flexor muscles. These seizures occur In all age groups, with symptoms ranging from rapid tremors to falling down. No loss of consciousness Is detectable because of the brief duration of the seizure. Myoclonic seizures often occur In combination with other seizure types. Valproate and clonazepam are used most often to treat myoclonic seizures lamotrigine and topiramate also have shown some efficacy. 

One unwanted side-effect of phenytoin is its anti-folate activity. A programme of synthetic chemistry to manipulate the structure of the anti-folate compound pyri-methium to try to replace that property with anticonvulsant activity resulted in the synthesis of lamotrigine. It proved to be an effective AED in partial and generalised epilepsy but experience has found it also to be of value in absence seizures. 

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... 

Depression is a common problem in patients with epilepsy, with approximately 30% having symptoms of major depression at some point.34 Patients with epilepsy should be routinely assessed for signs of depression, and treatment should be initiated if necessary. Certain AEDs may exacerbate depression, for example levetirac-etam and phenytoin. Other AEDs (e.g., lamotrigine, carba-mazepine, and oxcarbazepine) maybe useful in treating depression. Changes in mood can be precipitated by addition or discontinuation of an AED. If treatment for depression is necessary, caution should be exercised in choosing an agent that does not increase seizure frequency and does not interact with AEDs. 

Lamotrigine Levetiracetam Oxcarbazepine Tiagabine Topiramate Generalized seizures absence (newly diagnosed) ... 

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. 

The newer AEDs were first approved as adjunctive therapy for patients with refractory partial seizures. To date, lamotrigine, topiramate, and oxcarbazepine have received FDA approval for use in monotherapy in patients with partial seizures. Felbamate has monotherapy approval but causes significant side effects. 

Withdrawal seizures Do not abruptly discontinue AEDs because of the possibility of increasing seizure frequency in patients with epilepsy and weizures in bipolar patients. Unless safety concerns require a more rapid withdrawal, taper the dose of lamotrigine over a period of at least 2 weeks. 

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. 

Lamotrigine has a broad spectrum of action and is effective in generalized and partial epilepsies. Its primary mechanism of action appears to be blockage of voltage-dependent sodium channels, although its effectiveness against absence seizures indicates that additional mechanisms may be active. Lamotrigine is almost completely... 

An epileptic patient who is taking phenytoin and lamotrigine to control her seizures is in the first month of pregnancy and definitely wants to have the baby. What vitamin supplement would be essential ... 

Several new drugs have been recently approved by the EDA for the control of seizures (Curry and Kulling, 1998). Three of these, gabapentin, lamotrigine, and to-... 

Because of the possibility of increased seizure frequency, discontinuance of lamotrigine should be done gradually over a period of 2 weeks. Addition of DVP to lamotrigine therapy reduces lamotrigine clearance and increases steady-state plasma lamotrigine concentrations by 50% (AHFS, 2000). Conversely, steady-state plasma concentrations of lamotrigine are de-... 

Messenheimer, J., Ramsay, R.E., Willmore, L.J., Leroy, R.E, Zielinski, J.J., Mattson, R., Pellock, J.M., Valakas, A.M., Womble, G., and Risner, M. (1994) Lamotrigine therapy for partial seizures a multicenter, placebo-controlled, double-blind, cross-over trial. Epilepsia 35 113-21. 

Wallace, S.J. (1994) Lamotrigine—a clinical overview. Seizure 3 (Suppl A) 47-51. 

Uvebrant, P., and Bauziene, R. (1994) Intractable epilepsy in children the efficacy of lamotrigine treatment, including non-seizure-related benefits. Neuropediatrics 25 284—289. 

Lamotrigine has been approved as an adjunctive treatment for partial and generalized seizures. Its mechanism of action is thought to involve inhibition of glutamate release (227, 228). Open-label, case series reports and ongoing double-blind, controlled trials have explored this agent s usefulness in both bipolar mania and depression (229, 230). 

Lamotrigine was developed when some investigators thought that the antifolate effects of certain antiseizure drugs (eg, phenytoin) may contribute to their effectiveness. Several phenyltriazines were developed, and although their antifolate properties were weak, some were active in seizure... 

At least three drugs are effective against absence seizures. Two are nonsedating and therefore preferred ethosuximide and valproate. Clonazepam is also highly effective but has disadvantages of dose-related adverse effects and development of tolerance. Lamotrigine and topiramate may also be useful. 

Phenobarbital Enhances phasic GABAa receptor responses reduces excitatory synaptic responses Nearly complete absorption not significantly bound to plasma proteins peak concentrations in Vi to 4 h no active metabolites tjy2 varies from 75 to 125 h Generalized tonic-clonic seizures, partial seizures, myoclonic seizures, generalized seizures, neonatal seizures, status epilepticus Toxicity Sedation, cognitive issues, ataxia, hyperactivity Interactions Valproate, carbamazepine, felbamate, phenytoin, cyclosporine, felodipine, lamotrigine, nifedipine, nimodipine, steroids, theophylline, verapamil, others... 

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