Use of lamotrigine in medically intractable epilepsies in children
Smail Zubcevic1, Adisa Cengic, Feriha Catibusic
1Paediatric Clinic, Clinical Center, University of Sarajevo.
Insights
Lamotrigine add-on therapy effectively reduced seizures in children with medically intractable epilepsy. This newer antiepileptic drug demonstrated a good safety profile, offering a valuable treatment option.
Area of Science:
- Pediatric Neurology
- Clinical Pharmacology
Background:
- Medically intractable epilepsies are characterized by persistent seizures despite adequate trials of first-line antiepileptic drugs (AEDs).
- These conditions significantly impair patients' quality of life, necessitating alternative treatment strategies.
Purpose of the Study:
- To evaluate the efficacy and safety of lamotrigine as an add-on therapy for pediatric patients with medically intractable epilepsies.
- To determine the expected benefits of introducing lamotrigine in this patient population.
Main Methods:
- A study involving 61 children (aged 2-18 years) diagnosed with epilepsy and refractory to at least two first-line AEDs.
- Lamotrigine add-on therapy was initiated approximately 16 months post-diagnosis, with seizure frequency and side effects monitored.
Main Results:
- Significant seizure frequency reduction (76-100%) was observed in 37.70% of patients, with an additional 21.31% experiencing good reduction (51-75%).
- Partial seizures were the predominant type, and a higher chance of poor outcome was noted in these cases.
- Adverse events, primarily skin rash, were reported in 8.2% of patients, indicating a favorable safety profile.
Conclusions:
- Lamotrigine is an effective and well-tolerated treatment option for medically intractable epilepsies in children.
- The introduction of lamotrigine offers a new therapeutic avenue for managing refractory epilepsy, improving patient outcomes.
Abstract:
Medically intractable epilepsies are defined as seizures that are not controlled after an adequate trial with 2 first-line antiepileptic drugs (AED). Evidence in the literature show that these patients have many dysfunctions in their lifes. Lamotrigine is part of group of "newer antiepileptic drugs". Goal of this paper was to show what benefit is expected with introduction of add-on therapy with lamotrigine in patients with medically intractable epilepsies. Study was done in period 2002-2007 at Paediatric Hospital in Sarajevo. Inclusion criteria were: established diagnose of epilepsy, medical intractability defined as seizures not controlled after an adequate trial with 2 first-line antiepileptic drugs, age of more than 2 years and less than 18 years. Total of 61 children were assessed, 35 male and 26 female. Average age was 61.3 months at diagnosis of epilepsy. Add-on therapy with lamotrigine started in average about sixteen months after the diagnosis, with average age at starting the therapy of 77.4 months. Predominant type of seizures were partial seizures (with or without secondary generalization) in 67.20% cases, primarily generalized tonic clonic seizures in 13.11% cases, typical and atypical absences in 11.48% cases and myoclonic seizures in 8.20% cases. Reduction in seizure frequency was very good (76-100% reduction) in 37.70% of patients, good (51-75%) in 21.31%, fair (26-50%) in 9.84 and poor (less than 25%) in 31.14%. Chances of poor outcome were greater in patients with partial seizures. Side effects were noticed in 8.2% patients (6,56% with skin rash). Lamotrigine has showed good efficacy and safety profile. It is providing new efficient and well tolerated options for treatment for medically intractable epilepsies.
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