Lamotrigine Adjunctive Therapy in Lennox-gastaut Syndrome
Abstract number :
1.23
Submission category :
4. Clinical Epilepsy / 4C. Clinical Treatments
Year :
2022
Submission ID :
2204417
Source :
www.aesnet.org
Presentation date :
12/3/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:24 AM
Authors :
Hui Jin Shin, MD – Severance Children's Hospital; Hoon-Chul Kang, MD, PhD – Severance Children's Hospital; Heung Dong Kim, MD, PhD – Severance Children's Hospital; Joon Soo Lee, MD, PhD – Severance Children's Hospital; Se Hee Kim, MD – Severance Children's Hospital
Rationale: Lennox-Gastaut syndrome (LGS) is a severe developmental and epileptic encephalopathy that usually requires polytherapy of anti-seizure medication (ASM). Lamotrigine is often used as an adjunctive therapy; however, previous studies show that Lamotrigine may worsen myoclonic jerks in LGS patients. This study reviews the overall efficacy and safety of Lamotrigine in Lennox-Gastaut syndrome patients.
Methods: This retrospective study was conducted on 38 patients, diagnosed with Lennox-Gastaut syndrome, at Severance Children’s Hospital. Patients were aged 19 years and below, treated with Lamotrigine as an adjunctive therapy, between October 2020 and January 2022. Primary outcome was change in seizure frequency at 3 months, 6 months and 1 year after the initiation of Lamotrigine treatment.
Results: Thirty-eight patients were included. The median age of seizure onset was 2.56 (Interquartile Quartile ratio(IQR) 0.50-4.0) years. Etiology of LGS was structural in 17 patients (44.7%), unknown in 14 patients (36.8%). Seizure semiology at the start of treatment was convulsive in 15 patients (39.5%), spasm in 14 patients (36.8%), atonic in 5 patients (13.2%), myoclonic in 3 patients (7.9%), absence in 1 patient. The Electroencephalogram (EEG) background was significantly abnormal in 35 patients; twenty-four patients (63.2%) showed frequent epileptiform discharges, and eight patients (21.1%) showed occasional epileptiform discharges. The median number of anti-seizure medication was 3.95 (IQR, 3-4.75). Eighteen patients (47.4%) had a history of ketogenic diet; twenty-two patients (57.9%) had a history of cannabidiol. At 3 months follow-up, seizure frequency reduction of more than 50% was achieved in 47.4% of patients (18/38). At 6 months follow-up, 10 patients (10/24, 41.7%) showed significant seizure reduction; 12 patients (12/24, 50%) showed improvement in seizure frequency. There were 3 patients that showed myoclonic seizures at the start of treatment; All three patients showed no change in seizure frequency at 3 months follow-up.
Conclusions: Lamotrigine could be effective in the treatment of generalized seizures in Lennox-Gastaut syndrome. However, as previous studies indicate, myoclonic jerks may not show improvement after treatment.
Funding: None of the authors have any conflicts of interest to disclose.
Clinical Epilepsy