Efficacy of lamotrigine add-on therapy in severe partial epilepsy in adults with drop seizures and secondary bilateral synchrony on EEG

Objectives: To evaluate the efficacy of lamotrigine (LTG) add-on therapy in drug-resistant, partial epilepsy with epileptic drop attacks (EDA) and sec ondary bilateral synchrony (SBS) on EEG. Methods: We carried out a single-center, open-label, prospective study on a restricted group of patients experiencing an EDA frequency of at least one /month during the previous year regardless of multiple antiepileptic drug ( AED) trials. Study design consisted of three phases: a 3-month baseline per iod, a 4-month period in which LTG was titrated and a 9-month maintenance d ose observational period. LTG add-on therapy depended on valproate (VPA) as sociation, with a maximum of 200 mg/day with VPA and 600 mg/day in the abse nce of VPA. Every three months, patients underwent clinical, hematological and EEG evaluation including plasma level of AEDs. To assess the efficacy o f LTG add-on therapy, patients were required to keep a detailed seizure dia ry throughout the study. Results: Fourteen patients (nine men and five women), aged from 21 to 51, w ere included in the study. All of them had complex partial seizures (CPS), besides EDA, and half of them had secondarily generalized seizures (SGS). T wo of the 14 patients had to stop LTG due to side effects, although one of them was seizure-free after LTG. Twelve patients completed the study. The i mprovement was more than 50% for every type of seizure. SGS disappeared in three cases and improved by more than 50% in another three cases. EDA disap peared in six patients; and improved with more than 50% EDA reduction in fi ve patients. CPS disappeared in two patients and improved by more than 50% in eight. EEG improved in nine cases, with SBS disappearing in six patients . Conclusions: We have demonstrated a good efficacy of LTG adjunctive therapy on EDA. Results include control of SGS and improvement of EEG tracing.