The effects of lamotrigine on sleep in patients with epilepsy.
OBJECTIVE
The older antiepileptic drugs (AEDs) have a variety of effects on sleep, including marked reduction in REM, slow-wave sleep (SWS) and sleep latency, and increased percentage of light sleep. The effects of the newer AEDs on sleep are unknown. Our purpose was to study the effect of lamotrigine (LTG) on sleep.


METHODS
Ten adults with focal epilepsy, in whom the decision was made to add LTG to either phenytoin (PHT) or carbamazepine (CBZ) for control of seizures, were the subjects of this study. Patients underwent pre- and posttreatment polysomnography (PSG) and completed sleep questionnaires. Polygraphic variables and Epworth Sleepiness Scale (ESS) scores, a subjective measure of sleep propensity, were compared by using the Wilcoxon sign rank test.


RESULTS
Seven patients were taking CBZ, and three were treated with PHT. All subjects were titrated to an LTG dose of 400 mg/day. Treatment with LTG produced a significant decrease in SWS and an increase in stage 2 sleep percentage. No significant difference in ESS or any of the other polygraphic variables was observed. However, LTG treatment was associated with a reduction in arousals and stage shifts and an increase in REM periods. No subjects reported insomnia with treatment.


CONCLUSIONS
LTG appears to be less disruptive to sleep than some of the older AEDs.
Foldvary
N
N
Department of Neurology and Epidemiology, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. foldvan.ccf.org
Perry
M
M
Lee
J
J
Dinner
D
D
Morris
H H
HH
D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use*; D015331:Cohort Studies; D004827:Epilepsy / Q000188:drug therapy*; D005260:Female; D006801:Humans; D000077213:Lamotrigine; D008297:Male; D008875:Middle Aged; D017286:Polysomnography / Q000187:drug effects; D012890:Sleep / Q000187:drug effects*; D007319:Sleep Initiation and Maintenance Disorders / Q000139:chemically induced; D012895:Sleep, REM / Q000187:drug effects; D014227:Triazines / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use*
D000927:Anticonvulsants; D014227:Triazines; D000077213:Lamotrigine