Lamotrigine in Treatment of 120 Children with Epilepsy

Schlumberger, E; Chávez, Francisco Villalobos; Palacios, León; Rey, Elisabeth; Pajot, N; Dulac, Olivier

doi:10.1111/j.1528-1157.1994.tb02445.x

Cited by 193 publications

(94 citation statements)

References 16 publications

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“…In two studies of LTG for the treatment of childhood epilepsies, responses (i.e., 250% reduction in spasms) were seen in nine of 30 subjects with infantile spasms in one study ( 18) and four of 13 in another (19). Three of four patients with infantile spasms responded to FBM (20).…”

Section: Discussionmentioning

confidence: 99%

A Pilot Study of Topiramate in the Treatment of Infantile Spasms

1998

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Summary:Purpose: West syndrome is a rare epileptic syndrome associated with infantile spasms, a specific abnormal electroencephalographic pattern (termed hypsarrhythmia). and mental retardation. Management of this disorder is difficult because current treatment regimens, including many anticonvulsants and hormones, are often ineffective. Topiramate (TPM) is a new antiepileptic drug that may be effective in pediatric epilepsies. We conducted a pilot study to test the effects of rapid TPM dosing in patients with refractory infantile spasms.Methods: Eleven children with refractory infantile spasms were given an initial dose of 25 mg TPM per day in addition to their current therapy. Dosage was increased by 25 mg every 2-3 days until spasms were controlled, the maximal tolerated dose was reached, or the maximal dose of 24 mg/kg/day was achieved. Efficacy was primarily assessed by video EEG and secondarily by parental count of spasm frequency.Results: Five (45%) subjects became spasm free during the study, with absence of infantile spasms and hypsarrhythmia (either classic or modified) proven by video EEG. Nine s u b jects, including the five spasm free, achieved a spasm reduction of 250%. Spasm frequency decreased from 25.6 f 19.3 to 6.9 r 5.9 spasmdday. Sixty-four percent of the subjects were able to achieve TPM monotherapy.Conclusions: Results in this cohort of 1 1 patients with refractory disease show TPM to be a promising new agent for the treatment of infantile spasms.

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Section: Discussionmentioning

confidence: 99%

A Pilot Study of Topiramate in the Treatment of Infantile Spasms

1998

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“…61 Allergic rash occurs at a higher rate when patients are already taking VPA. [62][63][64] Valproate is a powerful inhibitor of lamotrigine metabolism, resulting in much higher serum levels of lamotrigine in the presence of VPA compared with enzyme-inducing AEDs. However, the mechanism of increased rash with the combination of lamotrigine and VPA is not fully explained by an increase in lamotrigine levels.…”

Section: Allergymentioning

confidence: 99%

Therapeutic Safety Monitoring: What to Look for and When to Look for It

Harden

2000

Epilepsia

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Summary: This review focuses on the safety problems associated with antiepileptic drugs (AEDs) as rcvealed by laboratory testing and clinical examination. There are two classes of side effccts: (a) common and mild and (b) rare and severe. Allergic reactions to AEDs are common and usually mild. However, on rare occasions, they can progress to more severe cutaneous disorders, including Stevens-Johnson syndrome and toxic epidermal necrolysis. Severe allergic reactions to AEDs range from immune responses with fever to multiorgan dysfunction. Allergic rashes may be genetically or immunologically determined. Laboratory abnormalities produced by AEDs are common and mild, and include hepatic enzyme elevation associated with phenytoin and mild elevation in ammonia associated with valproate. Serious, although rarc, idiosyncratic side effects, such as aplastic anemia, hepatotoxicity, and thrombocytopenia, have also occurred with AEDs. These reactions are largely confined to the "classic" AEDs. With the exception of felbamate, AEDs approved in the past decade have not been plagued by severe idiosyncratic reactions. Subtle endocrine abnormalities, including variations in thyroid function tests and bone metabolism, and the often subclinical effects on peripheral nerve conduction produced by phenytoin and carbamazepine, are also examined. Key Words: Adverse effect-Allergic reaction-StevensJohnson syndrome-Endocrine abnormalities.The vast majority of prescribed medications produce mild and non-life-threatening adverse effects. Although life-threatening events do occur, they not only are rare but also are idiosyncratic, preventing sufficient anticipation. Allergic rash is a fairly common adverse effect of some classes of medication. On rare occasions, the rash can cross categories from the common and mild to the serious and life-threatening.This review of antiepileptic drugs (AEDs) examines the frequency, course, and management of common and nonserious adverse effects, the risk and timing of rare but serious adverse effects, the subtle effects of AEDs on endocrine dysfunction, including thyroid, reproductive, and bone metabolism systems, and the common but mild effect of some AEDs on nerve conduction.

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“…1,22 On the other hand, tics, abnormal eye movements and movement disorders as observed in two patients are rare. [23][24][25] The mechanisms that cause abnormal eye movements and movement disorders are highly hypothetical.…”

Section: Discussionmentioning

confidence: 99%

Late side-effects of valproate and lamotrigine

Moreira

Thomé‐Souza

Valente

2007

J. epilepsy clin. neurophysiol.

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Lamotrigine (LTG) is a generally well-tolerated antiepileptic drug with broad-spectrum efficacy in several forms of partial and generalized epilepsy. Adverse effects of lamotrigine are usually associated with introduction and titration. This risk increases in children and in the co-medication with valproate. Herein, we report four patients with late adverse-effects, under the co-medication valproate and LTG, not related to drug introduction or titration. This study demonstrates that late side-effects without apparent etiology in children, adolescents and adults in chronic use of LTG, especially when associated to VPA, led to a diagnostic investigation, sometimes invasive. It must be emphasized that, due to the excellent seizure control, the authors opted for drug decrease instead of drug withdrawal, as previously done. Studies on late adverse effects are scarce, but physicians must be aware of these risks.Key words: lamotrigine, side-effects, epilepsy, anti-epileptic drugs. RESUMOEfeitos adversos tardios no uso de valproate e lamotrigina Lamotrigina (LTG) é uma droga antiepiléptica bem tolerada com eficácia em diferentes formas de epilepsia, parcial e generalizada. Os efeitos adversos da lamotrigina estão freqüentemente associados com a sua introdução e a sua titulação. Este risco encontra-se aumentado em crianças e quando a LTG é usada em associação com o valproato. Nós relatamos quatro pacientes que apresentaram efeitos adversos tardios com a co-administração de LTG e valproato, não relacionados à introdução ou o escalonamento das drogas antiepilépticas. Este estudo demonstra que efeitos adversos tardios sem etiologia aparente nas crianças, adolescentes e adultos em uso crônico de LTG, especialmente quando associados ao valproato, levou à investigação diagnóstica, por vezes invasiva. Os autores enfatizam que, devido ao bom controle de crises, os autores optaram pela redução da dose ao invés da suspensão da medicação, como previamente realizado. Embora os estudos sobre efeitos adversos tardios das drogas antiepilépticas sejam escassos, os clínicos devem estar cientes deste risco.Unitermos: lamotrigine, efeitos adversos, epilepsia, drogas antiepilépticas.

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Lamotrigine in Treatment of 120 Children with Epilepsy

Cited by 193 publications

References 16 publications

A Pilot Study of Topiramate in the Treatment of Infantile Spasms

A Pilot Study of Topiramate in the Treatment of Infantile Spasms

Therapeutic Safety Monitoring: What to Look for and When to Look for It

Late side-effects of valproate and lamotrigine

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