Is there a lamotrigine withdrawal syndrome?

To report a peculiar observation of a patient who developed a psychomotor inhibition state after a rapid cessation of lamotrigine (LTG).

This man was referred to us at the age of 26 years for presurgical evaluation. His treatment [valproate (VPA), 1200 mg/day and LTG, 200 mg/day] was quickly decreased and discontinued after 4 days in order to record seizures. Because LTG was ineffective on seizures control, it was decided to stop it definitively. After a few days, he became anhedonic. He had a tremor, a slight tachycardia and an important hyperhydrosis of the hands. He was considered as having a withdrawal reaction to LTG which was confirmed by spontaneous resolution after a few days.

Withdrawal syndrome caused by anti-epileptic drugs has been rarely reported. However, in our personal experience of patients monitored for epilepsy surgery, many patients complained of minor reactions when the treatments were quickly decreased. Severe reactions are exceptional and may be explained in this case by the pharmacodynamic effects of LTG. It has indeed been suggested that LTG could have psychostimulant and antidepressive effects.