Abstracts

RATIONALE: Because of possible weight gain, hair loss, and menstrual irregularities with valproic acid (VPA) treatment (2), lamotrigine (LTG) has been suggested as a first line therapy in women with Juvenile Myoclonic Epilepsy (JME). We report our experience with LTG in JME.
METHODS: 27 cases with an established diagnosis of JME were identified retrospectively. Diagnosis was established by clinical history of sporadic generalized tonic-clonic (GTC) seizures, morning myoclonic jerks, and an EEG with generalized [gt] 3 Hz polyspike-slow wave complexes. The age range was 15-53 years, mean of 32 years. 21 out of the 27 patients were women. Patients had been on LTG therapy for an average of 22 months, range of 3 to 37 months. The mean dose was of 310 mg/day, range of 150 - 700 mg/day. In most patients, the target dose was empirically set at 300 mg/day, with some patients requiring higher doses to achieve seizure or myoclonus control. Lower doses were kept in case of adverse effects.
RESULTS: Only 4 out of the 27 (14.8%) developed a dramatic exacerbation of their myoclonus leading to discontinuation of LTG. An additional two patients had a mild increase in their morning myoclonus which was tolerable and transient ([lt] 2 months duration). Other adverse effects included mild anxiety 4/27, mild transient rash 2/27 (which was managed by dose reduction), and dizziness 1/27. Seizure control was excellent (seizure-free) in 23/27 including several patients in whom LTG was discontinued due to increased myoclonus. Sporadic GTC seizures continued in 4/27 patients, in one patient this was attributed to poor compliance with therapy.
CONCLUSIONS: Our study suggests high efficacy of LTG for the treatment of JME with an exacerbation of myoclonus seen in a small number of patients. Other investigators have reported similar positive experience with the use of LTG for treatment of JME (3,4) as well as exacerbation of myoclonus (1). Further studies are needed to establish the degree of efficacy and tolerability of LTG in the treatment of JME patients. We believe that in light of concerning side effects that VPA present to the female patient, LTG should be consider as an alternate option.

1. Biraben A, et al. Exacerbation of Juvenile Myoclonic Epilepsy with lamotrigine. Neurology 2000;55:1758.
2. Isojarvi JIT,et al. Obesity and endocrine disorders in women taking valproate for epilepsy. Ann Neurol 1996;39:579-584
3. Timmings PL & Richens A. Efficacy of lamotrigine as monotherapy for Juvenile Myoclonic Epilepsy. Epilepsia 1993;34 (Suppl 2):160
4. Buchanan N. The use of lamotrigine in Juvenile Myoclonic Epilepsy. Seizure 1996;5:149-151.
Disclosure: Grant - Dr. Carrazana has participated in Glaxo Wellcome sponsored research studies. Honoraria - Dr. Stein and Dr. Carrazana has been a member of the Glaxo speaker[ssquote]s bureau.