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Lamotrigine--a clinical overview
1University Hospital of Wales, Heath Park, Cardiff, UK.
Insights
Lamotrigine effectively reduced seizures by over 50% in more than 30% of children with refractory epilepsy. This epilepsy medication was well-tolerated, with global improvement noted in 74% of young patients.
Area of Science:
- Pediatric Neurology
- Clinical Pharmacology
- Epileptology
Background:
- Refractory epilepsy in children presents significant treatment challenges.
- Limited data exists on lamotrigine's efficacy and tolerability in pediatric populations.
Purpose of the Study:
- To evaluate the efficacy and tolerability of lamotrigine as add-on therapy in children with refractory epilepsy.
- To assess long-term efficacy and potential tolerance development.
Main Methods:
- Pooled data from five identical protocols involving 285 children with refractory epilepsy.
- Open-label, add-on lamotrigine therapy assessed over 12 weeks of maintenance dosage.
- Review of smaller trials to confirm findings.
Main Results:
- Over 30% of patients achieved >50% seizure reduction across various epilepsy types.
- Investigator and parent evaluations showed global improvement in 74% of children.
- Lamotrigine was well-tolerated, with rash being the most common side effect (7.4% withdrawal), reduced by slow titration.
Conclusions:
- Lamotrigine demonstrates a broad spectrum of efficacy in pediatric refractory epilepsy.
- The drug is well-tolerated in children, with a favorable side effect profile compared to adults.
- No evidence of tolerance development was observed in children treated for over a year.
Abstract:
Data from five almost identical protocols have been pooled to give the results of treatment with lamotrigine in 285 children with refractory epilepsy. All the children received lamotrigine as open, add-on therapy and efficacy was assessed after the first 12 weeks of maintenance dosage. More than 50% reduction in seizures was achieved for over 30% of patients with complex partial, secondary generalized tonic-clonic, myoclonic, primary generalized tonic-clonic and atonic seizures; and, more than 50% of those with typical or atypical absences. In children treated for more than a year, there was no evidence of development of tolerance. Evaluations by investigators and parents found lamotrigine to improve the child globally in 74% of cases. Lamotrigine was well tolerated. Dizziness, unsteadiness and other non-specific side-effects that have been noted in a small minority of adults were rarely complained of by children. Rash was the most frequently reported side effect, leading to withdrawal of the drug in 7.4% of patients. However, the rate was lower when lamotrigine dosage was increased slowly as recommended. Data from other, smaller trials have also been reviewed and it is concluded that lamotrigine is a very well tolerated drug with a broad spectrum of efficacy.