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Lamotrigine-induced tic disorder: report of five pediatric cases
M A Sotero de Menezes1, J M Rho, P Murphy
1Department of Neurology, University of Washington School of Medicine, Seattle, Washington, USA. msoter@chmc.org
Insights
Lamotrigine (LTG) can rarely cause tics in children, including motor and vocal types. Children with language disorders may be more prone to this side effect.
Area of Science:
- Pediatric Neurology
- Pharmacology
- Movement Disorders
Background:
- Lamotrigine (LTG) is an anticonvulsant medication.
- Tics are uncommon side effects of LTG therapy.
Observation:
- A retrospective analysis identified five pediatric patients who developed tics during LTG treatment.
- The tics manifested as simple motor or vocal types.
- Tics often resolved after LTG discontinuation and recurred upon reintroduction.
Findings:
- Four patients presented with simple motor tics; one had predominantly vocal tics.
- No patients met diagnostic criteria for Tourette syndrome.
- Two patients had acquired epileptic aphasia syndrome, and others had various neurological conditions.
Implications:
- Lamotrigine may induce tics, particularly in children with pre-existing language dysfunction.
- Further research is needed to identify at-risk populations for LTG-induced tics.
- This highlights the importance of monitoring for new-onset movement disorders during LTG therapy.
Purpose:
To describe the clinical spectrum of lamotrigine (LTG)-induced tics (an uncommon side effect) in children.
Methods:
Retrospective analysis of patients from our hospital-based practice who developed tics while on LTG. Data obtained from medical records, interviews with parents, video-EEGs, and homemade videotapes.
Results:
Three males and two females (range, 2.5-12 years; mean, 6.9 years) developed a movement disorder within the first 10 months of therapy (maintenance doses, 4-17 mg/kg/day). Four patients exhibited simple motor tics; one patient experienced mostly vocal (i.e., gasping sounds) tics. Laryngoscopic evaluation of one 2.5-year-old with repetitive gasping sounds was normal. In three cases, tics resolved completely within 1 month of drug cessation; tics recurred in two of these patients after reintroduction of LTG. A fourth patient experienced gradual improvement after stopping LTG over 4 months; the fifth patient's simple motor tics improved spontaneously with a reduction in medication. None of the patients had clinical features of a neurodegenerative disorder, and none met diagnostic criteria for Tourette syndrome. Two patients, however, had a diagnosis of acquired epileptic aphasia syndrome, and one patient had nonprogressive expressive and receptive language dysfunction. A fourth patient had global static encephalopathy, and the fifth patient had only attentional problems. In all patients, tics were not associated with ictal EEG changes.
Conclusions:
LTG may infrequently induce simple motor tics, vocal tics, or both. Patients with severe language dysfunction may be particularly susceptible to this uncommon side effect. Further studies are necessary to clarify the population at risk.