Lamotrigine in refractory epilepsy

Introduction. Lamotrigine (LTG) is a new antiepileptic drug indicated in all kinds of partial and generalised clonic-tonic seizures, both in monotherapy and polytherapy. Between 20 and 30% of epileptic patients have poor control over their seizures despite adequate treatment. Aims. We report on our experience regarding the long-term efficacy and tolerability of LTG in refractory seizures. Patients and methods. We conducted a consecutive 10-year study of patients who began LTG therapy following poor control of their seizures, in spite of being treated with two or more antiepileptic drugs in monotherapy or in combination. Both their epidemiological and clinical data were, collected for study. We studied the efficacy of the treatment, differentiating between remission (absence of seizures), improvement (reduction > 50% of the seizures), inefficacy (reduction < 50%), exacerbation (increase in seizures) and its tolerability (side effects and dropout). Results. In all, data was collected from 39 patients, 18 males (46.2%), mean age 30.9 +/- 13.7 years; mean follow-up time: 27.6 +/- 23.4 months. 43.7% presented cryptogenic epilepsy, in 28.5% it was symptomatic and in the remaining 28.5% it was idiopathic. EEG readings and neuroimaging scans were pathological in 53.8% and 43.6%, respectively. After beginning therapy with LTG, 33% remained free of seizures, 43.6% improved, in 18.3% it was seen to be ineffective and 5.1% got worse. Dropout rate was 564%: 23.1% due to insufficient control over the seizures, 17.9% owing to side effects and 15.4% because of non-compliance. Conclusion. Treatment with LTG offers a high degree of efficacy in the control of seizures in patients with refractory epilepsy, although it is limited by a high dropout rate.