Abstract
Introduction: Epilepsy is a common neurological condition with an estimated incidence of 50 per 100,000 population and a prevalence five to ten per 1,000 population in developed countries. It is considered refractory when seizures are so frequent that the patient's ability to live fully is limited, when treatment does not control seizures, or when side effects are limiting for the normal development of the person. Lamotrigine is an antiepileptic drug that inhibits the sodium channel voltage-dependent presynaptic modulating excitatory transmitter glutamate and aspartate type.
Objective: To determine the effectiveness of Lamotrigine as monotherapy or in combination with conventional antiepileptic drugs in patients with refractory epilepsy.
Materials and methods: A descriptive study. Period May 2009 to November 2012. Variable analysis by frequency, averages and ratios.
Results: Sample: 115 medical records. 97.4% (112) of the patients have reduced the number of seizures, so than 85.2% (98) have had a reduction greater than or equal to 50%. There was an average of 9.45 attacks per month, with a median of 6 episodes, prior to treatment with this medicine, whereas after administering medication, the average was 3.65 episodes per month, with a median of 1 crisis/month. The average drugs used before initiating the Lamotrigine was 1.9 with a minimum of 1 and maximum of 6 and from the beginning of the Lamotrigine the average was 1.54, with minimum use of 1 and maximum of 4 drugs.
Conclusion: Lamotrigine is a last generation drug with great effectiveness and few side effects, which can effectively reduce the frequency of seizures in patients with refractory epilepsy.
References
SANDER JW, SHORVON SD. Epidemiology of the epilepsies. Journal of Neurology, Neurosurgery and Psychiatry 1996; 61(5):433-43.
HAUSER WA, ANNEGERS JF, KURLAND LT. The incidence of epilepsy in Rachester, Minnesota, 1935-1984. Epilepsia 34:453-468, 1993.
COCKERELL OC, JOHNSON AL, SANDER JW, HART YM, SHORVON SD. Remission of epilepsy: results from the national general practice study of epilepsy. Lancet 1995; 346:140-4.
KWAN P, ARZIMANOGLOU A, BERG AT, BRODIE MJ, HAUSER WA, MATHERN G, MOSHE' SL, PERUCCA E, WIEBE S, FRENCH J. Definition of drug resistant epilepsy: Consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia, 51(6):1069-1077, 2010.
DEVINSKY O. Patients with refractory seizures. N Engl J Med 1999; 340: 1.565-1.570.
CARRIZOSA MOOG J, CORNEJO OCHOA W. ¿Qué es la epilepsia refractaria? Latria / vol 16/no.2 / junio / 2003. 163-168.
DUCHOWNY M. Identification of Surgical Candidates and Timing of Operation: An Overview. En: Elaine W, ed. The Treatment of Epilepsy, 2ª ed. Baltimore: Williams & Wilkins; 1997: 967-975.
AICARDI J. General Aspects of Prognosis. En: Aicardi J, ed. Epilepsy in Children, 2ª ed. Philadelphia: Raven Press; 1993: 381-393.
GILMAN J, DUCHOWNY M, JAYAKAR P, RESNICK T. Medical intractability in children evaluated for epilepsy surgery. Neurology 1994; 44: 1.341-1.343.
JAYAKAR P, DUCHOWNY M, RESNICK T, ALVAREZ L, GILMAN J, DEAN P. Preoperative evaluation of intractable epilepsy in childhood. Int Pediatr 1998; 13: 197-201.
MOSHE S. Intractable seizures in infancy and early childhood. Neurology 1993; 43 (Suppl 5): S2-S7.
WILLIAM F; GIDAL, B. Lamotrigine. En Willie E, ed. The Treatment of Epilepsy. Baltimore: Lippincot William Wilkins; 2001: 933-939.
BIALER M, JOHANNESSEN S, KUPFERBERG H, LEVY R, PERUCCA E, TOMSON T. Progress report on new antiepileptic drugs: A Summary of the Eigth Eilat Conference (EILAT VIII). Epilepsy Research 2007; 73: 1-52.
AKMAN, I, HOLMES GL. The Effect Of Lamotrigin On The Eegs Of Children And Adolescents With Epilepsy. Epilepsy & Behavior 2003; 4:420-423.
SCHLUMBERGER E, CHAVEZ F, PALACIOS L, REY E, PAJOT N, DULAC O. Lamotrigine in treatment of 120 children with epilepsy. Epilepsia 1994; 35:359-67.
BOUNI S, GROSSO S, FOIS A. Lamotrigine treatment in childhood drug resistant epilepsy. J. Child Neurol 1998; 13:163-7.
SANDER JW, TREVISOL BP, HART YM, PATSALOS PN, SHORVON SD. The efficacy and long-term tolerability of lamotrigine in the treatment of severe epilepsy. Epilepsy Res 1990; 7:226-9.
MESSENHEIMER J, RAMSAY RE, WILLMORE LJ, LEROY RF, ZIELINSKI JJ, MATTSON R, ET AL. Lamotrigine therapy for partial seizures: a multicenter, placebo-controlled, double-blind, cross-over trial. Epilepsia 1994; 35:113-21.
LOISEAU P, YUEN AW, DUCHE B, MAENAGER T, ARNE BM. A randomised double-blind placebo-controlled crossover add-on trial of lamotrigine in patients with treatment-resistant partial seizures. Epilepsy Res 1990; 7:136-45.
MESSENHEIMER JA. Lamotrigine. Epilepsia 1995;36 (Suppl 2): S87-94.
MOELLER JJ, RAHEY SR, SADLER MR. Lamotrigine-valproic acid combination therapy for medically refractory epilepsy. Epilepsia 50(3):475-479, 2009.
MAURI-LLERDA JA, MORALES-MARTÍNEZ J, SALAS-PUIG FJ, VADILLO-OLMO D, CAMPOS MC, DÍAZ M, FERNÁNDEZ JM, PAZ-GONZÁLEZ O, VEGA-LÓPEZ. Estudio retrospectivo de la efectividad de la Lamotrigina en monoterapia para el tratamiento de crisis epilépticas. Estudio ERELMO. REV NEUROL 2008; 46 (4): 197-202.
BERAN RG, BERKOVIC SF, DUNAGAN FM, VAJDA FJ, DANTA G, BLACK AB, ET AL. Double-blind, placebo-controlled, crossover study of lamotrigine in treatment-resistant generalised epilepsy. Epilepsia 1998;39:1329-23.
TIJA-LEONG E, LEONG K, MARSON AG. Lamotrigine adjunctive therapy for refractory generalized tonic-clonic seizures. Cochrane Database of Systematic Reviews 2010, Issue 12.
BITON V, SACKELLARES JC, VUONG A, ET AL. Double-Blind, placebo-controlled study of lamotrigine in primary generalized tonic-clonic seizures. Neurology 2005; 65:1737 - 43.
MACHADO V, PALMINI A, ALMEIDA BASTOS F. Long-term control of epleptic drop attacks with the combination of valproate, lamotrigine and a benzodiazepine: A "proof of concept,"; open label study. Epilepsia, 52 (7): 1303-1310, 2011.
THOME-SOUZA S, MORERIRA B, VALENTE K. Late Adverse Effects of the Coadministration of Valproate and Lamotrigine. Pediatric Neurology 47:47-50, 2012.
THOME-SOUZA S, VALENTE K. Valproate and Lamotrigine in pediatric patients with refractory epilepsy: after the first year. Pediatric Neurology 48 (6):436-42, 2013.
RAMARATNAM S, MARSON AG, BAKER GA. Tratamiento complementario con Lamotrigina para la epilepsia parcial resistente a fármacos. Producido por Update software. Disponible en: http://www.update-software.com.
MCKEE JR, SUNDER TR, FINESMITH R, VUONG A, VARNER JA, BARRET PS. Lamotrigina as adjunctive therapy in patients with refractory epilepsy and mental retardation. Epilepsy Behav. 2003, Aug; 4 (4):386-394.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.