title: Changes of seizures activity during rapid withdrawal of lamotrigine.
abstract: Quantitatively evaluating the rapid withdrawal effects of lamotrigine (LTG) and carbamazepine (CBZ) on seizure activity during pre-surgical evaluation in patients with pharmacoresistant complex partial epilepsy. The duration and frequency of seizure activities and electrographic seizure onset of 41 patients totally withdrawing from CBZ monotherapy (n = 20), LTG monotherapy (n = 10) and CBZ + LTG combined therapy (n = 11) were intensively studied by therapeutic intensive seizure analysis (TISA) method. Study phases ran from the baseline phase to the antiepileptic drug (AED) withdrawal phase until the AED free phase, 3 days for each phase. Seizure duration and frequency obviously increased during the withdrawal process in each group (P < 0.05). The duration of secondarily generalized clonic signs markedly increased with the tapering of each drug; tonic signs, however, only in the AED free phase (P < 0.05). The frequency of secondary tonic and clonic signs only increased in the CBZ and CBZ + LTG group. Intergroup comparisons of all variables were insignificant (P > 0.05). There was no change of ictal EEG localization during all withdrawal protocols. All patients experienced more severe seizures during the withdrawal processes. An earlier aggravation of the clonic signs than the tonic signs was observed in each group. Difference between the withdrawal effects of LTG and CBZ monotherapy and LTG + CBZ polytherapy was mainly in the frequency change of ictal signs. The withdrawal process did not influence the ictal EEG localization. This study justified the withdrawal in pre-surgical localization, rationalized precautions for possible accompanying risks, and also aroused attentions in clinical anticonvulsant trials and substitutions involving withdrawal process.
authors.affiliation: Department of Neurology, Center of Epilepsy (ZEE), University of Erlangen-Nuremberg, Erlangen, Germany. wangying66@yahoo.com <wangying66@yahoo.com>
authors.forename: Y
authors.initials: Y
authors.lastname: Wang-Tilz
authors.forename: C
authors.initials: C
authors.lastname: Tilz
authors.forename: B
authors.initials: B
authors.lastname: Wang
authors.forename: E
authors.initials: E
authors.lastname: Pauli
authors.forename: C
authors.initials: C
authors.lastname: Koebnick
authors.forename: H
authors.initials: H
authors.lastname: Stefan
mesh_terms: D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects* / Q000097:blood; D002220:Carbamazepine / Q000009:adverse effects / Q000097:blood; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D004569:Electroencephalography / Q000187:drug effects / Q000379:methods; D005069:Evaluation Studies as Topic; D005260:Female; D049690:History, Ancient; D006801:Humans; D000077213:Lamotrigine; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D012189:Retrospective Studies; D012640:Seizures / Q000139:chemically induced* / Q000503:physiopathology; D013375:Substance Withdrawal Syndrome / Q000503:physiopathology; D016896:Treatment Outcome; D014227:Triazines / Q000009:adverse effects* / Q000097:blood
chemical_list: D000927:Anticonvulsants; D014227:Triazines; D002220:Carbamazepine; D000077213:Lamotrigine