Efficacy and safety of lamotrigine in refractory epilepsy of children

Yıl 2008, Cilt: 13 Sayı: 1-2, 7 - 12, 14.01.2013

Razieh Fallah Zia Islami Nasim Tavakoli

Öz

Abstract. It  is  known that  current  antiepileptic drugs can  not  control  seizures  in 20-30%  of patients. The aim of this study was to evaluate the efficacy and safety of lamotrigine as add-on therapy in intractable epileptic children in   Yazd- Iran. In  a  drug  study, 42   children with   mean age of 5/35 ± 4 years, 23  boys  and  19 girls  with     refractory   seizures and  seeking  treatment,   recruited   to be    subjects   of  this   study. Mixed  and  myoclonic  were the most common seizure types ( 38% and 31% respectively). At  the  end   of   three   months  of  lamotrigine treatment  concomitantly  with previous  AED, 31%   became   seizure   free, 35.7%  had   more  than   50% reduction  in seizure   frequency  and  12% had   increasing   seizures. All of seizures in absence and juvenile myoclonic epilepsies stopped with lamotrigine. Good drug response (stopping of   seizures or > 50% of reduction in seizure frequency) was seen in 100% of idiopathic, 67% of cryptogenic and 54% of symptomatic epilepsies.  75% of Lennox-Gastaut syndrome and progressive myoclonic epilepsy and 33% of West syndrome had good response. Drug rash was seen in 6.7% of children and serious hematologic abnormality, hepatotoxicity and nephrotoxicity side effects were not seen. Lamotrigine can be considered as an effective and safe drug   in controlling of intractable epilepsy of children especially in absence and juvenile myoclonic epilepsy.

Key words: Refractory  epilepsy, lamotrigine, add-on therapy, children

Anahtar Kelimeler

Refractory epilepsy, lamotrigine, add-on therapy, children

Kaynakça

• Johnson MV. Seizure in childhood. In: Behrman RE, Kliegman RM, Jenson HB. Nelson Textbook of Pediatrics (18th ed). Philadelphia, Saunders 2007; p 2457.
• Camfield PR, Camfield CS. Pediatric epilepsy . Swaiman KF, Ashwal S, Ferriero D M . Pediatric Neurology: principles & practice (4th ed). Philadelphia, Mosby Elsevier 2006: p 981.
• Lee CY, Fu WM, Chen CC, et al. Lamotrigine inhibits postsynaptic AMPA receptor and glutamate release in the dentate gyrus. Epilepsia 2008; 49: 897.
• Piña-Garza JE, Levisohn P, Gucuyener K, et al. Adjunctive lamotrigine for partial seizures in patients aged 1 to 24 months . Neurology 2008; 27 ; 70: 2099-2108.
• Naritoku DK, Warnock CR, Messenheimer JA, et al Lamotrigine extended-release as adjunctive therapy for partial seizures . Neurology 2007; 69: 1610
• Muñoz-Cabello B, Rufo-Campos M, Madruga- Garrido M, et al. Epileptic seizures in Angelman syndrome. Rev Neurol 2008; 47: 113-118.
• Valencia I, Piñol-Ripoll G, Khurana DS, et al Efficacy and safety of lamotrigine monotherapy in children and adolescents with epilepsy. Eur J Paediatr Neurol 2009; 13: 141-145.
• Mauri-Llerda JA, Morales-Martinez MD, Salas- Puig J, et al. A retrospective study of the effectiveness of lamotrigine in monotherapy for the treatment of epileptic seizures. [The ERELMO study]. Rev Neurol 2008; 46: 197-202.
• Bootsma HP, Vos AM, Hulsman J, et al. Lamotrigine in clinical practice: long-term experience in patients with refractory epilepsy referred to a tertiary epilepsy center Epilepsy Behav 2008; 12: 262-268.
• Kilaru S, Bergqvist AG . Current treatment of myoclonic astatic epilepsy: clinical experience at the Children's Hospital of Philadelphia. Epilepsia ; 48: 1703-1707.
• Barzagar M, Tonekaboni SH, Ghofrani M. Lamotrigine as add – on therapy in children with drug – resistant epilepsy (Iranian –experience). MJIRI 2003; 17: 15-18.
• Jian L, Nagarajan L, de Klerk N, et al. Seizures in Rett syndrome: an overview from a one-year calendar study. Eur J Paediatr Neurol 2007; 11: 317.
• Malphrus AD, Wilfong AA. Use of the newer antiepileptic drugs in pediatric epilepsies. Curr Treat Options Neurol 2007; 9: 256-267.
• Trevathan E, Kerls SP, Hammer AE, et al. Lamotrigine adjunctive therapy among children and adolescents with primary generalized tonic-clonic seizures. Pediatrics 2006; 118: 371-378.
• Hancock E, Cross H. Treatment of Lennox-Gastaut syndrome.Cochrane Database Syst Rev 2003; CD003277.
• Wong M, Trevathan E. Infantile spasms. Pediatr Neurol 2001; 24: 89-98.
• Ramaratnam S, Marson AG, Baker GA. Lamotrigine add-on for drug-resistant partial epilepsy. Cochrane Database Syst Rev 2001; CD001909.
• French, JA, Kanner, AM, Bautista, J, et al. Efficacy and tolerability of the new antiepileptic drugs I: treatment of new onset epilepsy: report of the Therapeutics and Technology Assessment Subcommittee and Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology 2004; 62: 1252-1260.
• Chung AM, Eiland LS. Use of second – generation antiepileptic drugs in the pediatric population. Paediatr Drugs 2008; 10: 217-254.
• Celebi A, Yalnmzoğlu D, Turanli G, et al. Lamotrigine in children with refractory epilepsy.Turk J Pediatr 2008; 50: 426-431.
• Gilad R, Sadeh M, Rapoport A, et al. Lamotrigine and catamenial epilepsy.Seizure 2008; 17: 531-534.
• Chen SJ, Chang KP, Wong TT, et al. Lamotrigine adjunctive therapy in children with refractory epilepsy: a medical center study . Acta Paediatr Taiwan. 2006; 47: 123-126.
• Zubcevic S, Cengic A, Catibusic F, et al. Use of lamotrigine in medically intractable epilepsies in children. Med Arh. 2008; 62: 162-164.
• Knoester PD, Boendermaker AJ, Egberts AC, et al. Cost-effectiveness of add-on lamotrigine therapy in clinical practice .Epilepsy Res 2005; 67: 143-151.
• Schmitz B, Bergmann L. The use of lamotrigine in female patients . Nervenarzt. 2007; 78: 912-922.
• Wheless JW, Clarke DF, Arzimanoglou A, et al. Carpenter D. Treatment of pediatric epilepsy: European expert opinion, 2007. Epileptic Disord ; 9: 353-412.
• Biton V, Sackellares JC, Vuong A, et al. Double- blind, placebo-controlled study of lamotrigine in primary generalized tonic-clonic seizures. Neurology 2005; 13; 65: 1737-1743.
• Motte J , Trevathan E , Arvidsson JFV, et al. Lamotrigine for generalized seizures associated with the Lennox – Gastaut syndrome. N Engl J Med 1997; 337: 1807-1812 .
• Timmings Pl , Richens A. Lamotrigine as add-on drug in the management of Lennox-Gastaut syndrome. Eur Neurol 1992; 32: 305-307.
• Alvestad S, Lydersen S, Brodtkorb E. Cross- reactivity pattern of rash from current aromatic antiepileptic drugs. Epilepsy Res 2008; 80: 194
• Baumann RJ, Fakhoury TA, Kustra RP, et al. Conversion to lamotrigine monotherapy from valproate monotherapy in older adolescent patients with epilepsy. Curr Med Res Opin 2007; 23: 2461