Abstracts

Rationale: Lamotrigine is indicated in the treatment of generalized and complex partial seizures in the pediatric and adult population. Lamotrigine has been reported in the past to cause exacerbation of myoclonic epilepsy. Review of the literature did not report exacerbation of any other seizure types. However we report four pediatric patients with both clinical and electrographic exacerbation of non-myoclonic generalized and complex partial seizure activity with Lamotrigine. Methods: The patients were ages 6 months to 10 years old. Two patients were diagnosed with complex partial seizure activity (right central sharps and multifocal spike waves) and the other two with generalized spike and wave activity (high amplitude spike/polyspike wave and polyspike wave of non-absence type) (Figure 1). Three of the patients were started on Lamotrigine as monotherapy, the 4th was on Keppra, Trileptal, Zonegran, Valium and Klonopin before the Lamotrigine was introduced. As their Lamotrigine dose was titrated upward, they all experienced an increase in clinical seizure activity as well as a corresponding increase in electrographic changes. (Figure 2). The titrating doses ranged from 3.5 mg/kg to 7 mg/kg. The increase in seizures occurred as soon as 2 months after the Lamotrigine was started. Three of the patients were weaned off the Lamotrigine and started on another AED. The seizure activity and electrographic changes decreased. The fourth patient improved after the Lamotrigine dose was titrated down by 3mg/kg. Results: The exacerbation of non-myoclonic epilepsy with Lamotrigine has had limited reporting. Two studies, one in Italy, Neurology, July 2004, reported a paradoxical reaction to Lamotrigine in a patient with idiopathic rolandic epilepsy, and an UK study, Seizure, April 1997, reported a 24% increase in seizures of patients with learning disabilities and epilepsy on Lamotrigine. Conclusions: What is also unclear is if the exacerbation of seizures is more likely with Lamotrigine monotherapy versus adjunctive therapy. Further studies to correlate this occurrence would be indicated.