Lamotrigine in the treatment of epilepsy in people with intellectual disability

Information about the mechanism of action and pharmacology of lamotrigine i s summarized. A brief review of the literature on the use of this drug in p eople with intellectual disability is followed by a suggested framework for evaluating antiepileptic drugs in this population. The role of lamotrigine is systematically examined against the suggested framework. This leads to the conclusion that lamotrigine is a very favourable drug for treating epil epsy in people with intellectual disability because it has a broad spectrum of action, is effective in treating subtle seizures, shows no loss of effe ct with time, is not usually sedative, does not produce difficult-to-manage adverse effects, appears to have no direct adverse behavioural effects and is available in a range of 'patient friendly' preparations. However, it is important to use the drug wisely. This implies starting with low doses of lamotrigine and escalating the dose slowly to avoid adverse effects, especi ally rash, and being aware of drug interactions which could cause difficult y, including the prolongation of half-life with valproate, the pharmacodyna mic interaction when it is added to carbamazepine and the pharmacokinetic i nteractions of lamotrigine with a number of antiepileptic drugs.