Late adverse effects of the coadministration of valproate and lamotrigine.
Individuals treated with combined valproate-lamotrigine rarely present late adverse effects (unrelated to introduction and titration). We describe four patients in whom such effects occurred after continuous, long-term use of valproate-lamotrigine (at 9 months to 2 years after final antiepileptic drug adjustment). The patients presented heterogeneous disturbances, including ataxia, vertigo, and headache, and rare movement disorders, such as tics and abnormal eye movements. Although these effects are heterogeneous in their occurrence and timing, they can alert physicians to the possibility of late neurologic disturbances, and must be considered in order to avoid unnecessary ancillary tests. Treatment discontinuation is unnecessary, given that a small decrease in dose led to remission of these adverse effects.
Laboratory of Clinical Neurophysiology, School of Medicine, University of São Paulo, and Hospital das Clínicas, São Paulo, Brazil. sigridethome@hotmail.com
Sigride
S
Thome-Souza
Bernardo
B
Moreira
Kette D
KD
Valente
D000293:Adolescent; D000927:Anticonvulsants / Q000009:adverse effects*; D001259:Ataxia; D002648:Child; D004359:Drug Therapy, Combination / Q000009:adverse effects; D004827:Epilepsy / Q000188:drug therapy; D005260:Female; D006261:Headache; D006801:Humans; D000077213:Lamotrigine; D008137:Longitudinal Studies; D008297:Male; D009069:Movement Disorders; D009422:Nervous System Diseases / Q000139:chemically induced*; D014227:Triazines / Q000009:adverse effects*; D014635:Valproic Acid / Q000009:adverse effects*; D014717:Vertigo
D000927:Anticonvulsants; D014227:Triazines; D014635:Valproic Acid; D000077213:Lamotrigine