Lamotrigine Adjunctive Therapy Improves Behavior in Persons with Refractory Epilepsy and Mental Retardation
Abstract number :
2.011
Submission category :
Year :
2000
Submission ID :
506
Source :
www.aesnet.org
Presentation date :
12/2/2000 12:00:00 AM
Published date :
Dec 1, 2000, 06:00 AM
Authors :
Jerry McKee, Theodore Sunder, Alain Vuong, Anne E Hammer, Pamela S Barrett, Western Carolina Ctr, Morganton, NC; Southern Illinois Univ Sch Med, Springfield, IL; Glaxo Wellcome Inc, RTP, NC.
RATIONALE: Epilepsy is a major comorbid condition in persons with mental retardation (MR). Optimal management of antiepilepetic drug therapy may be difficult in this population because there may be multiple seizure types that are refractory to medications. These individuals may also have concomitant behavioral and psychiatric disorders. LAMICTAL? (LTG) has been reported to enhance patients' alertness and social interaction in addition to a positive global improvement. METHODS: In a trial evaluating the efficacy and tolerability of LTG in persons with MR and refractory epilepsy (Neurology 2000;54,7,Suppl 3:A192), behavioral surveys (Aberrant Behavior Checklist, ABC; Habilitative Improvement Scale, HIS) were added as secondary measures. Persons (?12 yrs) with uncontrolled seizures despite treatment with ?3 AEDs, entered an 8 week baseline with doses of concurrent AEDs kept constant. LTG was titrated over the next 8 weeks, then during an 8 week maintenance, doses of all AEDs were held constant. During the next 12 weeks of optimization, the number and doses of all AEDs were adjusted as needed for optimal therapeutic response. Outcome measurements were the changes from baseline to week 36. RESULTS: N=67, 43% male, with mean age 29 years. Level of MR was 19% mild, 10% moderate, 12% severe, 58% profound. Patients' domicile was 46% institutions, 37% private families, 16% group homes. The most common seizure types were complex partial (49%), generalized tonic-clonic (40%). During optimization mean LTG dose was 403 mg/day for persons not taking VPA, 188 mg/day for persons with concurrent VPA. Efficacy results show that 11% became seizure free and 39% experienced ?50% decrease in seizures. Mean HIS score improvement (from 7.0 to 20.9) was highly significant (p<0.0001). All 5 ABC dimensions showed improvements, with mean scores improving significantly for Lethargy from 7.8 to 5.1 (p<0.008) and for Hyperactivity from 6.4 to 4.7 (p=0.06). CONCLUSIONS: Adjunctive therapy with lamotrigine decreased seizure frequency and inappropriate behavior and improved significantly maladaptive and social behavior in persons with refractory epilepsy and MR.