Abstracts

Lamotrigine has been associated with the development of tics. The occurrence of other types of movement disorders has not been well described.
PURPOSE: This purpose of the poster presentation is to describe the case of a child with a clinical picture strongly suggestive of Sydenham[apos]s chorea and four patients with Tourette[apos]s like syndrome, all of whom had remission of symptoms after lowering the dosage of Lamotrigine (LTG). This is a retrospective study aimed at identifying all patients who developed a movement disorder related to LTG. The patients had to have presented with the movement disorder after being started on LTG, and the symptoms had to have remitted after lowering or discontinuation of the LTG dosage. One girl, aged 54 months old, presented with continuous choreoathetotic movements only seen during wakefulness, and involving her head, face, all four extremities, and abdominal musculature. She has an underlying severe developmental delay and intractable secondary generalized epilepsy with multiple seizure types which appeared after an apparent encephalitic illness at 18 months old with the occurrence of dramatic developmental regression after an apparently normal early childhood. Six weeks prior to presentation, she had occurrence of positive Strep culture, ASO titers, and streptozyme, and received appropriate penecillin therapy. LTG levels had suddenly increased from 9 to 22, in the setting of slow taper and discontinuation from intercurrent ACTH, and continuing therapy with chlorazepate, while on LTG dose 25 mg/kg/d. CTV-EEG monitoring established the character of movements as non epileptic; movements dramatically regressed over a several day course of withholding LTG, then decreasing dosing to 13 mg/kg/d. Four patients, three children with focal onset epilepsy, and one adult with JME, developed multifocal tics and vocalizations at doses of 12-28 mg/kg/d with levels of 12 to 31, respectively. Symptoms remitted after the dose was lowered in all patients. None needed to have LTG discontinued. Movement disorders related to LTG can present as Tourette[apos]s syndrome and can mimic Sydenham[apos]s chorea. Our observations in the above set of patients demonstrate that it is not necessar to discontinue effective LTG therapy to achieve movement disorder symptom remission.