title: Lamotrigine--managing the challenging patient.
abstract: Childhood epilepsy presents many different challenges requiring a careful assessment and an individual management plan appropriate to the needs of each child. The first rule in managing the difficult-to-treat patient is to re-examine the diagnosis. The characterization of the seizures may also guide the clinician into prescribing the appropriate therapy. If the child has failed to respond to first-line antiepileptic drugs, the situation should be reviewed carefully. There may be a role for one of the new antiepileptic drugs. It is important to treat with adequate doses and for adequate duration before deciding whether a drug is effective or not. Failure to do this may deny the child the benefit of a particular medication. Drugs which affect behaviour or cause lethargy can have a secondary effect on cognition. Failure to treat frequent subtle seizures may also have serious cognitive consequences. Lamotrigine is of value in treating a variety of different seizure types, including subtle seizures, and has a low incidence of adverse effects.
authors.affiliation: St Piers Lingfield, Surrey, UK.
authors.forename: F M
authors.initials: FM
authors.lastname: Besag
mesh_terms: D000293:Adolescent; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002652:Child Behavior / Q000187:drug effects; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004827:Epilepsy / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007223:Infant; D007360:Intelligence / Q000187:drug effects; D000077213:Lamotrigine; D014227:Triazines / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000927:Anticonvulsants; D014227:Triazines; D000077213:Lamotrigine