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Query: UMLS:C0036572 (seizures)
 80,221 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In the treatment of epilepsy, benzodiazepines are often administered in combination with other antiepileptic drug (s) because of the development of tolerance. In this study, the influence of concurrently administered antiepileptic drugs on tolerance to the anticonvulsant action of the nitrazepam (NZP) was studied using an animal tolerance model. Mice were given vehicle, NZP alone or NZP concurrently with one of six antiepileptic drugs (carbamazepine CBZ, phenytoin PHT, zonisamide ZNS, vigabatrin VGB, lamotrigine LTG, or flunarizine FNR) twice daily for 5 days. Tolerance was assessed by the ability of NZP to prevent pentylenetetrazol-induced clonic convulsions. Tolerance developed in mice treated with NZP alone, NZP plus CBZ, PHT, ZNS, VGB or LTG. On the other hand, mice receiving NZP + FNR showed no tolerance; there was no significant difference in seizure frequency between the vehicle group and NZP + FNR group. These data suggest that co-administration of FNR but not CBZ, PHT, ZNS, VGB or LTG may delay if not prevent development of tolerance to the anticonvulsant action of benzodiazepines.
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PMID:[Influence of co-administered antiepileptic drugs on nitrazepam tolerance in mice]. 984 17

A collaborative survey was performed to compare prescribing strategies for the treatment of epilepsy in Mediterranean countries, based on analysis of 500 questionnaires compiled by physicians in 14 different countries. For partial seizures, carbamazepine was the drug of choice in most countries, whereas the second choice of drug differed widely. For primarily generalized tonic-clonic seizures, valproic acid was usually preferred, but other drugs used widely in some countries included phenobarbital, phenytoin and carbamazepine. Lamotrigine was the most popular second-line drug for primarily generalized tonic-clonic seizures in the European countries. In patients where the initial drug failed, switching to an alternative monotherapy was usually the preferred strategy, but advocates of early use of combination therapy exceeded 30% in the respondents of seven countries. Most respondents, in all countries except Turkey, did not prescribe drugs to prevent recurrence of febrile seizures; however, intermittent prophylaxis with a benzodiazepine was advocated by a considerable number of physicians, and continuous prophylaxis was prescribed by a significant minority of respondents in France, Syria and Tunisia. New drugs were rarely used as first-line treatment due to high cost and inadequate experience. Overall, this survey indicates that there is a wide variability in therapeutic practices between and within countries. This information may be useful for the implementation of national educational activities and for the design of pragmatic trials aimed at comparing different therapeutic strategies.
Seizure 1998 Dec
PMID:Therapeutic strategies against epilepsy in Mediterranean countries: a report from an international collaborative survey. 988 99

Lamotrigine is an anticonvulsant with a broad spectrum of activity that has been approved in the United States for use in adults with either partial or generalized seizures. This drug is being widely prescribed by pediatricians and neurologists because it is effective in children with idiopathic, resistant, generalized seizures and does not impair cognition. As with other anticonvulsants, a hypersensitivity syndrome has been described. Anticonvulsant hypersensitivity syndrome consists of the hallmark features of fever, rash, and lymphadenopathy. We report the first case of hypersensitivity syndrome in a child due to lamotrigine in which we believe the coadministration of valproic acid increased the duration of the reaction. Our patient had a high spiking fever, generalized morbilliform eruption, facial edema, lymphadenopathy, eosinophilia, atypical lymphocytosis, and an elevation in his liver function tests. The syndrome resolved with the discontinuation of the medication. Anticonvulsant hypersensitivity syndrome may occur with the administration of lamotrigine. Variable presentations may be seen, as hypersensitivity syndromes may be multisystem in nature. The prompt recognition of the signs and symptoms of this condition allows an accurate diagnosis so that the drug may be discontinued and other anticonvulsant treatment options instituted.
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PMID:Hypersensitivity reaction in a child due to lamotrigine. 1002

The effect of add-on administration of lamotrigine (1-12 mg/kg per day, 2-12 months) on the levels of neurotransmission related amino acids including gamma-aminobutyric acid (GABA), glutamate, aspartate, glycine and antiepileptic drugs (AEDs) in lumbar cerebrospinal fluid (CSF) was studied in 22 children and young adults with generalised therapy resistant epilepsy. Two lumbar punctures were performed, one prior to, and one following a mean of 5 months (2-12 months) of lamotrigine treatment. Lamotrigine decreased seizure incidence and severity in 12 of the 22 patients without influencing CSF GABA, glutamate, aspartate or glycine levels. Lamotrigine did not alter the concentrations of AEDs in CSF or plasma. However, CSF GABA levels were 86% higher in those patients also treated with gamma-vinyl-GABA (vigabatrin, GVG) compared with patients treated with other combinations and this was not altered by co-medication with lamotrigine. The proposed mechanism of action of lamotrigine, namely that it may inhibit glutamate release in the CNS, is not reflected by changes in CSF glutamate levels. The present findings indicate that CSF GABA, glutamate, aspartate and glycine levels may not be useful as in vivo neurochemical markers in young patients responding to the therapeutic dose of lamotrigine used in this study.
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PMID:Analysis of CSF amino acids in young patients with generalised refractory epilepsy during an add-on study with lamotrigine. 1019 15

The diagnosis, treatment, and prognosis of childhood absence epilepsy (CAE) and juvenile absence epilepsy (JAE) were reviewed with reference to 94 patients with typical absence seizures (82 with CAE, 12 with JAE) and the literature. The patients were separated into two groups based on clinical features, age at onset of seizures, and EEG findings. There has been much discussion on the age that represents the borderline between CAE and JAE. My view is that JAE begins with puberty, i.e. at around 10 years old. The treatment of choice for CAE is valproic acid (VPA). If the seizures are not controlled with VPA, add-on therapy with ethosuximide is recommended. For patients who respond poorly to these drugs, clonazepam in often effective. Lamotrigine, which is not yet commercially available in Japan, is effective when combined with VPA. As for school performance, some patients showed excellent results. However, about half of them performed weakly. Patients followed beyond 20 years were free of absence seizures in both groups, but suffered from GTCS with occurred sporadically in CAE as well as in JAE. The social prognosis in CAE and JAE may not be as good as we believed it to be.
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PMID:[Problems surrounding absence seizures]. 1035 59

The choice of the adequate antiepileptic treatment is based on the clinical experience more than rationality. During some decades, the combination of two antiepileptic drugs was considered the initial treatment but monotherapy showed more advantages (effectiveness, fewer adverse events, fewer teratogenic effects and better compliance). New antiepileptic drugs have increased our interest and knowledge of the epilepsies. They have changed some of our therapeutical schemes. Sodium valproate continues to be considered the choice treatment for all the idiopathic, cryptogenic and symptomatic generalized epilepsies. Lamotrigine and topiramate are two valid alternatives in these epileptic syndromes. In West's syndrome vigabatrin is considered the initial treatment. Carbamacepine, vigabatrine and tiagabine are not indicated in the treatment of generalized idiopathic epilepsies especially in patients with absence seizures. In focal epilepsies, both cryptogenic and symptomatic all the antiepileptic drugs have shown efficacy and the choice treatment is based on the adverse events and the teratogenic power. Prospective studies in patients with the same type of seizures and epileptic syndromes will allow us to determine the more adequate antiepileptic treatment.
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PMID:[Rational choice of antiepileptic treatment]. 1037 64

Lamotrigine (LTG) is an anti-epileptic drug effective in partial seizures and generalized epilepsy. There is growing evidence of the usefulness of LTG in childhood (CAE) orjuvenile (JAE) absences resistant to previous treatment. In this study all patients were identified using strict diagnostic criteria and subdivided into two groups. (1) Eight patients affected by absence seizures resistant to valproic acid or ethosuximide, received LTG as an-add-on therapy, (2) seven patients affected by typical absence seizures not previously treated, received LTG monotherapy after the diagnosis. In the patients with resistant absence seizures, a full control of seizures was obtained. In five of them, after a mean period of 12.5 months, the previous anti-epileptic drugs were withdrawn leaving the patients on LTG monotherapy. In one patient, absences relapsed and valproic acid was therefore added again to LTG to regain control of the seizures. In six of the seven patients on LTG monotherapy after the diagnosis, a full control of seizures was obtained. In the seventh patient the drug was stopped due to a skin rash. In conclusion LTG appears to be effective in resistant absence seizures in combination with valproic acid. Moreover, our preliminary data suggest that lamotrigine might be used as monotherapy in typical absence seizures. The advantages and disadvantages of LTG monotherapy in this type of epilepsy are discussed.
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PMID:Lamotrigine in typical absence epilepsy. 1041 16

Lamotrigine is a new antiepileptic drug that is effective for a broad range of seizures in adults and children. Three children with seizures of different causes who were treated with lamotrigine and developed reversible hepatotoxicity are reported. In one child, this therapy led to relatively severe hepatic failure that required and responded to aggressive therapy. Unlike most of the previously reported six patients with similar severe hepatic involvement, this patient's liver function and blood hepatic enzymes became normal. All three patients were on multiple drugs, and two were in epilepsia partialis continua secondary to encephalitis. Two of the patients had relatively rapid medication titration schedules. The close time relationship between the initiation of the lamotrigine therapy and the reversal of the liver abnormalities with lamotrigine discontinuation argues against a cause other than the lamotrigine; however, because of the complexity of the reported cases, the causality remains an assumption. Review of the literature revealed six other previously reported patients (five adults and one child) who had hepatotoxicity during lamotrigine therapy, with or without associated multisystem failure, and similar patient profiles. Lamotrigine is generally a safe and effective medication; however, it should be used with caution in patients on polytherapy and in those with complicated acute systemic and central nervous system conditions, such as fever, status epilepticus, epilepsia partialis, and encephalitis.
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PMID:Potential hepatotoxicity of lamotrigine. 1066 6

Over the last decade, many new drugs have been added to the therapeutic armamentarium for epilepsy. These drugs differ considerably in their mechanisms of action and, consequently, in their spectrum of efficacy against various seizure types. Oxcarbazepine, gabapentin, tiagabine and vigabatrin are especially useful in the management of partial seizures (with or without secondary generalization) and, probably, also primarily generalized tonic-clonic seizures, with vigabatrin being of particular value also in the treatment of infantile spasms. The spectrum of efficacy of lamotrigine and topiramate is broader than that of the other drugs and includes, in addition to partial and tonic-clonic seizures, also drop attacks associated with the Lennox-Gastaut syndrome. Lamotrigine is also effective against absence seizures, while the activity of topiramate as a potential anti-absence drug has not been adequately explored. Oxcarbazepine, vigabatrin and tiagabine may aggravate myoclonic and absence seizures and, likewise, gabapentin may aggravate myoclonic seizures. Therefore, the latter drugs should not be used (or used with great caution) in patients with syndromes associated with these seizure types. Apart from differences in spectrum of efficacy, side effect profiles also differ considerably from one drug to another, with the risk of serious adverse effects limiting considerably the use of felbamate and vigabatrin. When added to preexisting therapy in patients with refractory epilepsies, the new drugs improve seizure frequency in 15% to 40% of cases, but only rarely freedom from seizures is achieved. In newly diagnosed patients, the efficacy of the new drugs is similar to that of older agents, but further studies are required to confirm the claim that the tolerability of some of these agents is superior to that of established drugs such as carbamazepine or valproate. The new antiepileptic drugs represent a useful addition to the therapeutic armamentarium, but because of limited clinical experience and cost considerations their firstline use cannot be recommended in most situations.
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PMID:The spectrum of the new antiepileptic drugs. 1067 40

Little information exists about the effects of newer antiepileptic drugs (AEDs) on sexual function in men with epilepsy. We report a series of three male veterans whose sexual disorders improved with lamotrigine. All three had partial seizures. One patient was taking phenobarbital and gabapentin and complained of decreased potency and anorgasmia. After lamotrigine was added for better seizure control and the dosage of gabapentin was tapered, anorgasmia improved. The second patient complained of impotence after a rash while taking phenytoin and carbamazepine. Impotence persisted with phenobarbital, valproate, and gabapentin. Eight months after gabapentin was replaced with lamotrigine, impotence improved. The third patient complained of long-standing impotence. Treatment with five AEDs had no effect on the dysfunction. Lamotrigine was added to the carbamazepine regimen; impotence improved with decrease in carbamazepine and increase in lamotrigine. The favorable effect of lamotrigine on sexual disorders in these three patients suggests this drug should be considered under appropriate circumstances for men who have sexual dysfunction while taking other antiepileptic agents.
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PMID:Improved sexual function in three men taking lamotrigine for epilepsy. 1072 28


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