Abstracts

Rationale: Optimal antiepileptic drug (AED) treatment for persons with epilepsy (PWE) and/or mood disorders maximizes therapeutic response and minimizes adverse effects (AEs).  Key to therapeutic AED treatment is compliance.  Noncompliance is often related to severity of AEs.  Frequently, PWE do not spontaneously report and clinicians do not specifically query critical AEs that lead to noncompliance, including sexual dysfunction.  Sexual dysfunction prevalence in PWE ranges from 40-70%, often related to AEDs, epilepsy, or mood states.  This case reports lamotrigine-induced sexual dysfunction leading to periodic noncompliance. Methods: Case analysis with PubMed literature review. Results: A 56-yo-male patient with Major Depression, Panic Disorder without agoraphobia, PTSD was  well controlled with escitalopram 20mg bid, mirtazapine 22.5mg qhs, alprazolam 1mg tid prn.  Comorbid conditions included complex partial seizures, psychogenic nonepileptic seizures (PNES), hypertension, GERD, hydrocephalus with patent ventriculo-peritoneal shunt that were effectively treated with lamotrigine 100mg tid, enalapril 20mg qam, lansoprazole 30mg qam.  He acknowledged noncompliance with lamotrigine secondary to sexual dysfunction.  With lamotrigine 300mg total daily dose, he described no libido with impotence/anejaculation/anorgasmia.  When off lamotrigine for 48 hours, he described becoming libidinous with decreased erectile dysfunction but persistent anejaculation/anorgasmia.  When off lamotrigine for 72 hours to maximize sexual functioning, he developed auras.  Family confirmed patient’s consistent monthly noncompliance for 2-3 days during the past year. Conclusions: Sexual dysfunction is a key AE leading to AED noncompliance.  This case describes dose-dependent lamotrigine-induced sexual dysfunction with episodic noncompliance for 12 months.  Patient/clinician education regarding AED-induced sexual dysfunction is warranted as are routine sexual histories to ensure compliance. Funding: None