Lamotrigine for adults and children: new indication. A noteworthy improvement in the assessment file

(1) The indications for lamotrigine have been extended as monotherapy for adults, and in combination for children over 2 years of age. (2) In adults, two comparative trials have established that the efficacy of lamotrigine monotherapy is not significantly different from that of carbamazepine. (3) In children, lengthy non comparative trials suggest a positive effect of lamotrigine when it is added to ongoing inadequately effective treatment, especially for patients with absences, atonic seizures and tonic-clonic seizures. In contrast, lamotrigine can increase the frequency of myoclonic seizures in some cases. (4) In patients with the Lennox-Gastaut syndrome, the addiction of lamotrigine to an ongoing inadequately effective treatment proved more effective than a placebo in two methodologically sound trials. (5) Potentially severe cutaneous adverse effects calls for special precautions during the introduction of lamotrigine, taking account of aggravating factors such as combination with valproate sodium and too rapid a dose increment in the first two months of treatment.