Abstracts

RATIONALE: Although lamotrigine (LTG) and topiramate are FDA approved only for partial epilepsy, these 2 drugs are also used in Juvenile myoclonic epilepsy (JME) patients. Lamotrigine (LTG) results in 70- 80% seizure-free rate in JME, but little is known about its tolerability. The tolerability and efficacy of Topiramate (TPM) in the treatment of JME is unknown. We compared the efficacy of LTG and TPM on different seizure types and evaluated their tolerability in the treatment of JME. At the end of this activity the participants should be able to understand advantages and disadvantages of LTG and TPM therapies in JME.
METHODS: Charts of JME patients treated with LTG and TPM were evaluated for control of different seizure types. Forty eight patients received LTG and/or TPM. Age of patients ranged between 19-50. Fifteen patients were male and 33 were female. The criteria for classification of seizure control were as follows: I. GTC - good ([lt]1/yr), moderate (1-4/yr), poor ([gt]4/yr); myoclonic (Mcl) - good ([lt]5/mth,rare or occasional), moderate (5-14/mth or few), poor ([gt]15/mth or daily); absence - ([lt]5/mth, rare or occasional), moderate (5-14/mth or few), poor ([gt]15/mth or daily).
RESULTS: Data is given in Table. 62% of LTG and 78% of TPM treated patients received polytherapy. LTG and TPM did not differ significantly in GTC and Mcl seizure control, however, the control of Mcl seizure was suboptimal with both drugs. LTG was also effective in controlling absence seizures. The number of patients treated with TPM for absence seizures was inadequate. Seizure control did not differ when patients receiving LTG monotherapy were compared with patients receiving LTG polytherapy (data not included in table). A similar comparison was not possible for TPM treated patients due to inadequate numbers. The relative risk of withdrawal from the TPM therapy was twice compared with LTG therapy (p= 0.035). For both LTG and TPM, nearly 2/3 of the patients were withdrawn from the therapies due to side effects and the remaining 1/3 due to inefficacy.
CONCLUSIONS: LTG is effective in JME patients as monotherapy and polytherapy whereas TPM is effective as polytherapy. Seizure control did not differ when patients receiving LTG monotherapy were compared with patients receiving LTG polytherapy. This finding suggests that LTG monotherapy may be as good as polytherapy, however, this conclusion may not be definitive because the patient selection was not randomized. The withdrawal rates for both drugs was 57 and 29% respectively. More effective therapy is needed to improve the control of Mcl seizures.[table1]
(Disclosure: Grant - Ortho McNeill and Glaxo Wellcome, Consulting - Ortho McNeill, Honoraria - Ortho McNeill and Glaxo Wellcome)