Lamotrigine and seizure aggravation in severe myoclonic epilepsy.
OBJECTIVE
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, no change in three, and improvement in one. There was >50% increase in convulsive seizures in eight (40%) of 20 patients. Myoclonic seizures worsened in six (33%) of 18 patients. Of five patients improving in at least one seizure type, four had concomitant worsening of more invalidating seizures. Clear-cut worsening appeared within 3 months in most patients but was insidious in some. LTG was suspended in 19 patients after 15 days-5 years (mean, 14 months) with consequent improvement in 18.


CONCLUSIONS
The pronounced seizure deterioration during LTG treatment was not attributable to the natural course of the disease and could be a direct effect of therapeutic LTG doses. LTG treatment seems inappropriate in SME.
Guerrini
R
R
Institute of Child Neurology and Psychiatry, University of Pisa, Calambrone, Italy.
Dravet
C
C
Genton
P
P
Belmonte
A
A
Kaminska
A
A
Dulac
O
O
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D015897:Comorbidity; D004359:Drug Therapy, Combination; D004831:Epilepsies, Myoclonic / Q000139:chemically induced* / Q000188:drug therapy* / Q000453:epidemiology; D004828:Epilepsies, Partial / Q000139:chemically induced / Q000188:drug therapy / Q000453:epidemiology; D004829:Epilepsy, Generalized / Q000139:chemically induced / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D006801:Humans; D000077213:Lamotrigine; D008297:Male; D014227:Triazines / Q000009:adverse effects* / Q000627:therapeutic use
D000927:Anticonvulsants; D014227:Triazines; D000077213:Lamotrigine