LAMOTRIGINE AND SEIZURE AGGRAVATION IN SEVERE MYOCLONIC EPILEPSY

Purpose: In severe myoclonic epilepsy of infancy (SME), multiple drug- resistant focal and generalized seizure types occur. Lamotrigine (LTG) , found effective in many generalized and partial seizures, has been l ittle used in severe childhood epilepsy syndromes with multiple seizur e types. We studied the effects of LTG in SME. Methods: Twenty-one pat ients with SME, aged 2-18 years, were treated with LTG, 20 in add-on a nd one in monotherapy. LTG was started at 0.2-2.5 mg/kg/day and increa sed to 2.5-12.5 mg/kg/day. For each seizure type, excluding atypical a bsences, >50% variations compared with the 2 months preceding LTG were considered indicators of response, also taking into account the degre e of disability each seizure type produced. Results: LTG induced worse ning in 17 (80%) patients, no change in three, and improvement in one. There was >50% increase in convulsive seizures in eight (40%) in 20 p atients. Myoclonic seizures worsened in six (33%) of 18 patients. Of f ive patients improving in at least one seizure type, four had concomit ant worsening of more invalidating seizures. Clear-cut worsening appea red within 3 months in most patients but was insidious in some. LTG wa s suspended in 19 patients after 15 days-5 years (mean, 14 months) wit h consequent improvement in 18. Conclusions: The pronounced seizure de terioration during LTG treatment was not attributable to the natural c ourse of the disease and could be a direct effect of therapeutic LTG d oses. LTG treatment seems inappropriate in SME.