Lamotrigine serum levels: Ceiling effect in people with epilepsy in remission?

D'Anto, Jennifer; Wnuk, W; Rossetti, Andrea O.; Décosterd, Laurent A.; Buclin, Thierry; Nový, Jan

doi:10.1016/j.yebeh.2017.03.031

Cited by 11 publications

(12 citation statements)

References 16 publications

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“…Fourthly, the relationship between blood or brain exposure and therapeutic efficacy might display important between-patient pharmacodynamic variability: a similar observation was done for lacosamide in the same clinical setting (Perrenoud et al, 2017). Making a parallel with chronic epilepsy in an outpatient setting, most of the medication effect in responders is usually obtained at low dosage, and increasing doses seem to bring little additional benefit in terms of remission (D'Anto et al, 2017;Poolos et al, 2017) Our response rate to LEV was 34%, lower than previous studies with similar dosages that reported rates of 68.5% in 204 episodes (Yasiry and Shorvon, 2014), or 65.4% in 156 episodes (Trinka and Dobesberger, 2009). Direct comparisons are however difficult, because the definition of clinical response was not uniform across those studies and most of them, as ours, had a retrospective design making them prone to inclusion bias.…”

Section: Discussionmentioning

confidence: 87%

Levetiracetam circulating concentrations and response in status epilepticus

Perrenoud

André

Buclin

et al. 2018

Epilepsy & Behavior

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Section: Discussionmentioning

confidence: 87%

Levetiracetam circulating concentrations and response in status epilepticus

Perrenoud

André

Buclin

et al. 2018

Epilepsy & Behavior

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“…The main mechanism of oxcarbazepine is inhibiting the repeated discharge of neurons by blocking voltage-dependent sodium ion channels in brain cells (21). The main mechanism of lamotrigine is inhibiting voltage-dependent calcium and sodium channels to control the temperature of the presynaptic membrane and inhibit the release of neurotransmitters, ultimately reducing abnormal discharge of neurons (22). The HAMD and MADRS scores of patients from both groups before and after treatment were also compared.…”

Section: Discussionmentioning

confidence: 99%

Comparison of clinical efficacy of oxcarbazepine and lamotrigine combined with escitalopram, and impact on prognostic quality of life in treating patients with epilepsy and depressive disorder

Zhang

Zhao

2020

Exp Ther Med

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This study aimed to investigate the clinical efficacy of oxcarbazepine and lamotrigine combined with escitalopram in treating patients with epilepsy and depressive disorder, and their influence on the prognostic quality of life. A total of 108 patients with epilepsy and depression were selected as research participants. Among them, 53 patients were treated by oxcarbazepine combined with escitalopram (group A) and 55 patients were treated by lamotrigine combined with escitalopram (group B). Following six-month treatment, efficacy, epilepsy frequency and duration, Hamilton Depression Rating (HAMD) and Montgomery-Asberg Depression Rating (MADRS) scores, adverse reactions, improvement of electroencephalogram (EEG) epileptic discharge, quality of life, 1-year drug retention rate and withdrawal reasons of the two groups were compared. There was no remarkable difference in the total efficacy rate between both groups. The number and duration of epileptic seizures, improvement of EEG epileptic discharge and quality of life in the two groups significantly improved after treatment, with no marked difference. HAMD and MADRS scores of patients from group B were significantly lower after treatment compared with those of patients from group A. The incidence rate of adverse reactions in group B was dramatically lower compared with group A, and the 1-year drug retention rate of group B was dramatically higher compared with that in group A. Both oxcarbazepine and lamotrigine combined with escitalopram exhibited good efficacy in patients with epilepsy and depressive disorder, and they may effectively improve the prognostic quality of life of patients. Lamotrigine combined with escitalopram presented with a better antidepressant effect and safety, with higher patient tolerance.

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“…Their pharmacokinetic characteristics make newer generation ASM’s potentially good candidates for TDM 10 . Recently, we reported that maximal efficacy of LTG could be reached at blood levels below 8.2 mg/L, representing a ceiling concentration associated with seizure freedom in that retrospective cohort 11 …”

Section: Introductionmentioning

confidence: 94%

Seizure freedom and plasma levels of newer generation antiseizure medications

et al. 2021

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Objectives Contrary to older antiseizure medications (ASM), correlation between plasma levels and seizure freedom is not well defined for newer generation ASM. We assessed correlations between efficacy and newer generation ASM plasma levels in patients with epilepsy. Materials and Methods Plasma medication levels were measured over two years in consecutive patients taking lamotrigine, levetiracetam, oxcarbazepine, topiramate, zonisamide, lacosamide, perampanel or pregabalin. Seizure freedom was defined as three times the longest inter‐seizure pre‐treatment interval, or at least one year. Each medication level was stratified according to its position in relation to its proposed reference range (below or in lower half vs upper half or above). Results 168 patients on stable therapy were included. ASM plasma levels of seizure‐free patients were lower than those with ongoing seizures; 45/48 (93.7%) were in the lower half or below the reference ranges, compared to 86/106 (81.1%; p = .004). Lamotrigine plasma levels were significantly lower in seizure‐free patients (median 2.4 mg/L range 0.4–6.5 mg/L, none above 6.5 mg/L) compared with those with ongoing seizures (5 mg/L, 0.5–14.2 mg/L; p < .0001). Levetiracetam showed similar results (7.2 mg/L, 1.6–15.1 mg/L; none above 15.1 mg/L in seizure‐free patients vs 16.4 mg/L, 0.6–47.7 mg/L; p = .005). Demographics, epilepsy type and polytherapy did not influence the results. Conclusions Efficacy of newer generation ASMs seems to be reached at the lower part or at times even below the reference ranges in drug responsive patients; this could inform regarding titrations of these treatments.

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Lamotrigine serum levels: Ceiling effect in people with epilepsy in remission?

Cited by 11 publications

References 16 publications

Levetiracetam circulating concentrations and response in status epilepticus

Levetiracetam circulating concentrations and response in status epilepticus

Comparison of clinical efficacy of oxcarbazepine and lamotrigine combined with escitalopram, and impact on prognostic quality of life in treating patients with epilepsy and depressive disorder

Seizure freedom and plasma levels of newer generation antiseizure medications

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