Lamotrigine and Seizure Aggravation in Severe Myoclonic Epilepsy

Abstract

Summary: Purpose:In severe myoclonic epilepsy of infancy (SME), multiple drug-resistant focal and generalized seizure types occur. Lamotrigine (LTG), found effective in many generalized and partial seizures, has been little used in severe childhood epilepsy syndromes with multiple seizure types. We studied the effects of LTG in SME.Methods: Twenty-one patients with SME, aged 2-18 years, were treated with LTG, 20 in add-on and one in monotherapy. LTG was started at 0.2-2.5 mg/kg/day and increased to 2.5-12.5 mg/kg/day. For each seizure type, excluding atypical absences, >50% variations compared with the 2 months preceding LTG were considered indicators of response, also taking into account the degree of disability each seizure type produced.Results: LTG induced worsening in 17 (80%) patients, noSevere myoclonic epilepsy (SME) in infants (1) is one of the most disabling epileptic syndromes. Seizures begin during the first year of life in previously normal children as generalized or unilateral attacks, facilitated by fever, and often occurring in the form of status epilepticus. Such seizures are followed later, between ages 1 and 4 years, by myoclonus, atypical absences, and complex partial seizures, accompanied in some children by clinical photosensitivity. Often coinciding with the onset of myoclonus, there is a slowing in psychomotor development, patients being variably mentally retarded from school age on. All seizure types are extremely resistant to drug treatment. Although SME is diagnosed only in -1% of patients with epilepsy (2), the management of these patients is particularly time demanding and costly, as they undergo multiple periods of hospitalization and antiepileptic drug (AED) trials in which almost all combinations of available drugs are tried.Lamotrigine (LTG) has proven to be effective in the

Tratamento de epilepsia: consenso dos especialistas brasileiros

“…Estes achados refletem o que é referido na literatura médica, visto que a etossuximida é considerada excelente droga para ausências tí-picas 35 . A lamotrigina é menos efetiva para crises mioclônicas em comparação com o valproato 36,37 (Fig 5).…”

Aggravation of epilepsy by anti‐epileptic drugs

“…The seizure types that worsened were myoclonic, clonic, and tonic-clonic. 18 Others have observed the same phenomenon; however, some patients appear to improve on LTG, and the current position is to regard it as relatively contraindicated in this syndrome. Gabapentin (GBP) may aggravate absence epilepsy and myoclonic seizures.…”

“…These include the appearance of absence seizures in BECTS, myoclonic status in high doses, and deterioration of seizures in SMEI. 18,27 In a child with BECTS, LTG at a dose of 5mg/kg/day in combination with valproate produced frequent absences associated with 3/s sharp-and slow-wave complexes that could be provoked by hyperventilation. This was accompanied by cognitive and speech deterioration.…”

Audit of use of stiripentol in adults with Dravet syndrome

“…Sodium channel blockers, for example, carbamazepine, oxcarbazepine and phenytoin, should usually be avoided as they can aggravate both seizures and interictal EEG 9. Lamotrigine can also cause seizure exacerbation,10 although has been reported to be beneficial in some cases 11. Effective treatment strategies include valproic acid, clobazam, topiramate, levetiracetam, fenfluramine and bromides,12, 13, 14 or dietary therapies (ketogenic or modified Atkins diet) 15.…”