Elsevier

Pediatric Neurology

Volume 23, Issue 2, August 2000, Pages 160-163
Pediatric Neurology

Original article
Lamotrigine monotherapy in children

https://doi.org/10.1016/S0887-8994(00)00162-4Get rights and content

Abstract

The effectiveness of lamotrigine as a monotherapeutic agent for a variety of pediatric epilepsies was reviewed retrospectively. Children were categorized as having focal vs generalized epilepsy and according to whether they were antiepileptic drug naive or drug exposed. Data collected included dosages, side effects, length of follow-up, number of prior drugs, and treatment response. Treatment was considered successful if the patient was seizure free for 6 months or more. Eighty-three children were identified (average age = 8.7 years); 43 had focal epilepsy, 32 had generalized epilepsy, and eight were not classified. Twenty-nine patients were classified as having specific syndromes. Fourteen patients were drug naive. The median follow-up period was 8 months (mean = 8.5). Overall, 45% were seizure free, 44% with focal epilepsy and 36% with generalized epilepsy. All children with juvenile myoclonic epilepsy and benign rolandic epilepsy of childhood were seizure free, although not all had been treated for at least 6 months. One third of drug-naive patients were seizure free. Rash was the most common side effect and was reported in five patients (6%); two patients discontinued the drug. None had Stevens-Johnson syndrome. One quarter of children experienced nonquantifiable improvements, namely increased alertness and improved behavior regardless of seizure control. Lamotrigine is effective as a monotherapeutic agent in children for both focal and generalized epilepsies. Side effects are relatively uncommon. Lamotrigine may be an effective firstline agent.

Introduction

Lamotrigine (LTG) is a novel antiepileptic drug (AED) labeled for adjunct treatment of refractory focal-onset and secondarily generalized epilepsies in adults [1], [2]. Recently, it has received Food and Drug Administration approval for monotherapy in adults with focal-onset seizures. Despite this labeling, it appears to have a broad spectrum of activity against a variety of seizure types and epileptic syndromes [1], [2]. Few data exist on the effectiveness of this agent as a firstline drug in the treatment of epilepsy or as a monotherapeutic agent in children. We retrospectively examined the effectiveness of LTG as a monotherapeutic agent for a variety of pediatric epilepsies.

Section snippets

Methods

The study was conducted at the M.S. Hershey Medical Center from April 1995 to April 1997. Children treated with LTG monotherapy were identified through a retrospective chart review. To be included in the study, all children had to have a diagnosis of epilepsy with at least two unprovoked seizures before initiation of LTG therapy and had to be receiving LTG for at least 1 month. Where possible, children were classified as having either focal or generalized epilepsies and specific epileptic

Results

Eighty-three children (36 males and 47 females) were included, with an average age of 8.7 years (range 18 months to 20 years). One patient was an adult (20 years of age) who was included because she was diagnosed with juvenile myoclonic epilepsy in early adolescence and was transitioned to LTG because of intolerable side effects from valproate. Fourteen were newly diagnosed patients (AED naive); the remaining 69 were taking other AEDs and were transitioned to LTG monotherapy or had a remote

Discussion

The results of the present retrospective review of pediatric patients treated with LTG monotherapy suggests that LTG is effective as a monotherapeutic agent for a variety of pediatric epilepsies. Overall, 45% of children in this study treated for at least 6 months with LTG monotherapy were seizure free. In previously untreated children, remission was achieved in 38%. LTG appeared equally effective in children with either focal-onset or generalized epilepsies.

LTG is an effective monotherapeutic

Acknowledgments

We thank T. Kuhn, PhD for his editorial comments and M. Weidler for assistance in the preparation of the manuscript.

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