Abstracts

RATIONALE: There are no specific symptom that have been described following the abrupt discontinuation of lamotrigine (LTG), other than an increase in the frequency of seizures.
METHODS: We report a peculiar observation of a patient who developed a psychomotor inhibition state after a rapid cessation of the drug.
RESULTS: This man was referred to us at 26 years for presurgical evaluation. His treatment (valproate, 1200 mg/day and LTG, 200 mg/day) was quickly decreased and discontinued after four days in order to record seizures. Because LTG was ineffective, it was decided to stop it definitively. Levetiracetam was added to VPA. After a few days, he became anhedonic. The patient claimed that he had the impression that he was floating or that he had drunk alcohol. He had a slight tachycardia and an hyperhydrosis. He was considered as having a withdraw reaction to LTG which was confirmed by spontaneous resolution after a few days.
CONCLUSIONS: Withdrawal syndrome due to antiepileptic drugs has been rarely reported. However, in our personal experience of patients monitored for epilepsy surgery, many patients complain of minor reactions such as malaise, hyperhydrosis or tremors. Severe reactions are exceptional and may be explained in this case by the pharmacodynamic effects of LTG. It has indeed been suggested that LTG could have psychostimulant and antidepressive effects. Physicians should be alerted that psychomotor inhibition may occur after an abrupt discontinuation of the drug. They have an important role to play in preventing and recognizing this benign reaction.