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Management of Epilepsy

Defining the Role of Lamotrigine

  • Drugs in Disease Management
  • Published:
Disease Management & Health Outcomes

Summary

Epilepsy is a common condition with multiple potential causes that may present as a variety of types of seizure. Drug therapy is the mainstay of treatment, with seizures being controlled by monotherapy in approximately 60% of patients. In a minority of patients, seizures are controlled by combinations of antiepileptic drugs. Approximately 20% of patients have treatment-resistant epilepsy which, in some cases, will respond to surgical treatment.

The management of epilepsy with drugs requires a clear diagnosis of the type of epilepsy. One or several individual drugs are then tested initially as monotherapy and in combination if necessary until efficacy is established.

The use of older drugs (e.g. phenytoin, carbamazepine, etc.) is generally well established in the treatment of different types of epilepsy. Although other agents have their place, valproic acid (sodium valproate) appears to be the only agent with a sufficiently broad spectrum of activity to allow its use in all types of epilepsy. Valproic acid and carbamazepine are often used as first-line treatment for patients with partial epilepsy. However, adverse effects or drug interactions often dictate the choice between older antiepileptic drugs. In assessing newer agents, differences in efficacy, tolerability, drug interactions and contraindications often make treatment choices clear. Furthermore, several newer drugs are licensed only for add-on therapy, which restricts their use.

Lamotrigine is a newer antiepileptic drug with efficacy in most seizure types. It has been demonstrated to be effective and well tolerated when added to established antiepileptic drug regimens in adults and children, and as monotherapy in adults. Although it must be introduced slowly to minimise the possibility of skin rash, once at maintenance dosages it may be administered once or twice daily. The tolerability and drug interaction profiles of lamotrigine are well characterised. Thus, lamotrigine provides an effective and generally well tolerated alternative to older and newer antiepileptic drugs in the treatment of a variety of types of epilepsy.

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References

  1. Goa KL, Ross SR, Chrisp R Lamotrigine: a review of its pharmacological properties and clinical efficacy in epilepsy. Drugs 1993 Jul; 46: 152–76

    Article  PubMed  CAS  Google Scholar 

  2. Fitton A, Goa KL. Lamotrigine: an update of its pharmacology and therapeutic use in epilepsy. Drugs 1995 Oct; 50: 691–713

    Article  PubMed  CAS  Google Scholar 

  3. Commission on Epidemiology and Prognosis International League Against Epilepsy. Guidelines for epidemiologic studies on epilepsy. Epilepsia 1993; 34(4): 592–6

    Article  Google Scholar 

  4. Berg AT, Testa FM, Levy SR, et al. The epidemiology of epilepsy: past, present, and future. Neurol Clin 1996 May; 14: 383

    Article  PubMed  CAS  Google Scholar 

  5. Annegers JF, Rocca WA, Hauser WA. Causes of epilepsy: contributions of the Rochester Epidemiology Project. Mayo Clin Proc 1996 Jun; 71: 570–5

    Article  PubMed  CAS  Google Scholar 

  6. Sander JWAS, Shorvon SD. Epidemiology of the epilepsies. J Neurol Neurosurg Psychiatry 1996 Nov; 61: 433–43

    Article  PubMed  CAS  Google Scholar 

  7. Shorvon SD. The epidemiology and treatment of chronic and refractory epilepsy. Epilepsia 1996; 37 Suppl. 2: S1–3

    Article  PubMed  Google Scholar 

  8. Engel Jr J. Concepts of epilepsy. Epilepsia 1995; 36 Suppl. 1: S23–9

    Article  PubMed  Google Scholar 

  9. Hauser WA. Recent developments in the epidemiology of epilepsy. Acta Neurol Scand 1995; 92 Suppl. 162: 17–21

    Google Scholar 

  10. de la Court A, Breteler MMB, Meinardi H, et al. Prevalence of epilepsy in the elderly: the Rotterdam Study. Epilepsia 1996 Feb; 37: 141–7

    Article  PubMed  Google Scholar 

  11. From the Centers for Disease Control and Prevention. Prevalence of self-reported epilepsy — United States, 1986–1990. JAMA 1994 Dec 28; 272: 1893

    Article  Google Scholar 

  12. From the Centers for Disease Control and Prevention. Hospitalization for epilepsy — United States, 1988–1992. JAMA 1995 Dec 6; 274: 1670

    Article  Google Scholar 

  13. Cockerell OC, Hart YM, Sander JWAS, et al. The cost of epilepsy in the United Kingdom: an estimation based on the results of two population-based studies. Epilepsy Res 1994 Jul; 18: 249–60

    Article  PubMed  CAS  Google Scholar 

  14. Begley CE, Annegers JF, Lairson DR, et al. Cost of epilepsy in the United States: a model based on incidence and prognosis. Epilepsia 1994 Nov–Dec; 35: 1230–43

    Article  PubMed  CAS  Google Scholar 

  15. The treatment of epilepsy (part 2). MeReC Bull 1995 Jul; 6: 25–8

  16. Devinsky O. Cognitive and behavioral effects of antiepileptic drugs. Epilepsia 1995; 36 Suppl. 2: 46–65

    Article  Google Scholar 

  17. Mutani R, Cantello R, Gianelli M, et al. Antiepileptic drugs and mechanisms of epileptogenesis: a review. Ital J Neurol Sci 1995 May; 16: 217–22

    Article  PubMed  CAS  Google Scholar 

  18. Pellock JM. Antiepileptic drug therapy in the United States: a review of clinical studies and unmet needs. Neurology 1995 Mar; 45 Suppl. 2: S17–24

    PubMed  CAS  Google Scholar 

  19. Schmidt D, Gram L. Monotherapy versus polytherapy in epilepsy: a reappraisal. CNS Drugs 1995 Mar; 3: 194–208

    Article  Google Scholar 

  20. Troupin AS. Dose-related adverse effects of anticonvulsants. Drug Saf 1996 May; 14: 299–328

    Article  PubMed  CAS  Google Scholar 

  21. Britton JW, So EL. Selection of antiepileptic drugs: a practical approach. Mayo Clin Proc 1996 Aug; 71: 778–86

    Article  PubMed  CAS  Google Scholar 

  22. Isojärvi JIT, Laatikainen TJ, Knip M, et al. Obesity and endocrine disorders in women taking valproate for epilepsy. Ann Neurol 1996; 39: 579–84

    Article  PubMed  Google Scholar 

  23. Bryant III AE, Dreifuss FE. Hepatotoxicity associated with antiepileptic drug therapy: avoidance, identification and management. CNS Drugs 1995; 4(2): 99–113

    Article  CAS  Google Scholar 

  24. Delgado-Escueta AV, Janz D. Consensus guidelines: preconception counseling, management, and care of the pregnant woman with epilepsy. Neurology 1992 Apr; 42 Suppl. 5: 149–60

    PubMed  CAS  Google Scholar 

  25. Bialer M, Johannessen SI, Kupferberg HJ, et al. Progress report on new antiepileptic drugs: a summary of the Third Eilat Conference. Epilep Res 1996 Nov; 25: 299–319

    Article  CAS  Google Scholar 

  26. Fisher R, Blum D. Clobazam, oxcarbazepine, tiagabine, topiramate, and other new antiepileptic drugs. Epilepsia 1995; 36 Suppl. 2: S105–14

    Article  PubMed  CAS  Google Scholar 

  27. Grant SM, Faulds D. Oxcarbazepine: a review of its pharmacology and therapeutic potential in epilepsy, trigeminal neuralgia and affective disorders. Drugs 1992; 43(6): 873–88

    Article  PubMed  CAS  Google Scholar 

  28. Grant SM, Heel RC. Vigabatrin: a review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in epilepsy and disorders of motor control. Drugs 1991; 41(6): 889–926

    Article  PubMed  CAS  Google Scholar 

  29. Goa KL, Sorkin EM. Gabapentin: a review of its pharmacological properties and clinical potential in epilepsy. Drugs 1993 Sep; 46: 409–27

    Article  PubMed  CAS  Google Scholar 

  30. Mullens L, Gallagher J, Manasco P, et al. Improved neurological function accompanies effective control of the Lennox-Gastaut syndrome with Lamictal®: results of a multinational, placebo-controlled trial [abstract]. Epilepsia 1996; 37 Suppl. 5: 163

    Google Scholar 

  31. Mitchell R Paediatric lamotrigine use hit by rash reports. Lancet 1997 Apr 12; 349: 1080

    Article  Google Scholar 

  32. Kälviäinen R, Äikiä M, Riekkinen Sr PJ. Cognitive adverse effects of antiepileptic drugs: incidence, mechanisms and therapeutic implications. CNS Drugs 1996 May; 5: 358–68

    Article  Google Scholar 

  33. Lee DO, Steingard RJ, Cesena M, et al. Behavioral side effects of gabapentin in children. Epilepsia 1996; 37(1): 87–90

    Article  PubMed  CAS  Google Scholar 

  34. Wolf SM, Shinnar S, Kang H, et al. Gabapentin toxicity in children manifesting as behavioral changes. Epilepsia 1996; 36(12): 1203–5

    Article  Google Scholar 

  35. Sonnen AEH. Oxcarbazepine and oral contraceptives [abstract no. G1l]. Acta Neurol Scand 1990; 82 Suppl. 133: 37

    Google Scholar 

  36. Medical Research Council Antiepileptic Drug Withdrawal Study Group. Prognostic index for recurrence of seizures after remission of epilepsy. BMJ 1993 May 22; 306: 1374–8

    Article  Google Scholar 

  37. Willmore LJ. Management of epilepsy in the elderly. Epilepsia 1996; 37 Suppl. 6: S23–33

    Article  PubMed  CAS  Google Scholar 

  38. National Institutes of Health Consensus Conference. Surgery for epilepsy. JAMA 1990 Aug 8; 264: 729–33

    Article  Google Scholar 

  39. Dam M. Epilepsy surgery. Acta Neurol Scand 1996 Aug; 94: 81–7

    Article  PubMed  CAS  Google Scholar 

  40. Salinsky MC, Uthman BM, Ristanovic RK, et al. Vagus nerve stimulation for the treatment of medically intractable seizures: results of a 1-year open-extension trial. Arch Neurol 1996 Nov; 53: 1176–80

    Article  PubMed  CAS  Google Scholar 

  41. Prasad AN, Stafstrom CF, Holmes GL. Alternative epilepsy therapies: the ketogenic diet, immunoglobulins, and steroids. Epilepsia 1996; 37 Suppl. 1: S81–95

    Article  PubMed  Google Scholar 

  42. Rambeck B, Wolf P. Lamotrigine clinical pharmacokinetics. Clin Pharmacokinet 1993 Dec; 25: 433–43

    Article  PubMed  CAS  Google Scholar 

  43. Matsuo F, Gay P, Madsen J, et al. Lamotrigine high-dose tolerability and safety in patients with epilepsy: a double-blind, placebo-controlled, eleven-week study. Epilepsia 1996 Sep; 37: 857–62

    Article  PubMed  CAS  Google Scholar 

  44. Brodie MJ, 105 Study Group. Lamotrigine substitution study: evidence for synergism with valproate [abstract]. Epilepsia 1996; 37 Suppl. 4: 6

    Google Scholar 

  45. Besag FMC, Panayiotopoulos C, Chivers F, et al. Therapeutic interaction of lamotrigine with valproate and suximides [abstract]. Epilepsia 1995; 36 Suppl. 3: S116

    Google Scholar 

  46. Pisani F, Oteri G, Russo M, et al. Effects of lamotrigine-valproate comedication on seizure frequency and upper limb tremor: a pharmacodynamic interaction? [abstract]. Epilepsia 1995; 36 Suppl. 3: S264

    Google Scholar 

  47. Kilpatrick ES, Forrest G, Brodie MJ. Concentration-effect and concentration-toxicity relations with lamotrigine: a prospective study. Epilepsia 1996 Jun; 37: 534–8

    Article  PubMed  CAS  Google Scholar 

  48. Eriksson A-S, Hoppu K, Nergårdh A, et al. Pharmacokinetic interactions between lamotrigine and other antiepileptic drugs in children with intractable epilepsy. Epilepsia 1996; 37(8): 769–73

    Article  PubMed  CAS  Google Scholar 

  49. Wieser HG, Truog B, Vogt H, et al. The Swiss lamotrigine study: results of an open, multicenter, add-on treatment with lamotrigine in drug-resistant epileptic patients [abstract]. Epilepsia 1995; 36 Suppl. 3: S114–5

    Google Scholar 

  50. Reunanen M, Dam M, Yuen AWC. A randomised open multicentre comparative trial of lamotrigine and carbamazepine as monotherapy in patients with newly diagnosed or recurrent epilepsy. Epilep Res 1996 Mar; 23: 149–55

    Article  CAS  Google Scholar 

  51. Herranz JL, Arteaga R, Armijo JA. Three-year efficacy and tolerability of add-on lamotrigine in treatment-resistant epileptic children. Clin Drug Invest 1996 Apr; 11: 214–23

    Article  Google Scholar 

  52. Baruzzi A, di Virgilio R, Study Group on Lamotrigine. Results of the Italian multicenter study of lamotrigine in treatment-resistant epilepsy [abstract]. Epilepsia 1995; 36 Suppl. 3: S115

    Google Scholar 

  53. Boas J, Dam M, Friis ML, et al. Controlled trial of lamotrigine (Lamictal®) for treatment-resistant partial seizures. Acta Neurol Scand 1996 Oct; 94: 247–52

    Article  PubMed  CAS  Google Scholar 

  54. Ferrie CD, Robinson RO, Knott C, et al. Lamotrigine as an add-on drug in typical absence seizures. Acta Neurol Scand 1995 Mar; 91: 200–2

    Article  PubMed  CAS  Google Scholar 

  55. de Haan GJ, Beun AM, Engelsman M, et al. Postmarketing experience with vigabatrin and lamotrigine in a Dutch epilepsy center: a one-year follow-up in 200 patients [abstract]. Epilepsia 1996; 37 Suppl. 4: 63

    Google Scholar 

  56. Anonymous. Lamotrigine. In: PDR Generics. 2nd ed. Montvale, (NJ): Medical Economics, 1996: 1832–7

  57. Wellcome. Lamotrigine. In: British National Formulary. 32nd ed. London: British Medical Association and Royal Pharmaceutical Association of Great Britain, 1996: 206–7

    Google Scholar 

  58. Wellcome Medical Division. Lamictal Tablets. In: ABPI Data Sheet Compendium, 1994–95. London: Datapharm Publications Limited, 1994: 1775–7

    Google Scholar 

  59. Brodie MJ, Richens A, Yuen AWC, et al. Double-blind comparison of lamotrigine and carbamazepine in newly diagnosed epilepsy. Lancet 1995 Feb 25; 345: 476–9

    Article  PubMed  CAS  Google Scholar 

  60. Tennis P, Stern RS. Risk of serious cutaneous disorders after initiation of use of phenytoin, carbamazepine, or sodium valproate: a record linkage study. Data on file. Glaxo Wellcome

  61. Data on file. Glaxo Wellcome

  62. Appleton RE. The new antiepileptic drugs. Arch Dis Child 1996 Sep; 75: 256–62

    Article  PubMed  CAS  Google Scholar 

  63. Murray MI, Halpern MT, Leppik IE. Cost of refractory epilepsy in adults in the USA. Epilep Res 1996 Mar; 23: 139–48

    Article  CAS  Google Scholar 

  64. Cockerell OC. Pharmacoeconomic considerations in the drug treatment of epilepsy. CNS Drugs 1996 Dec; 6: 450–61

    Article  CAS  Google Scholar 

  65. O’Neill BA, Trimble MR, Bloom DS. Adjunctive therapy in epilepsy: a cost-effectiveness comparison of alternative treatment options. Seizure 1995 Mar; 4: 37–44

    Article  PubMed  Google Scholar 

  66. Hughes D, Cockerell OC. A cost minimization study comparing vigabatrin, lamotrigine, and gabapentin for the treatment of intractable partial epilepsy. Seizure 1996; 5: 89–95

    PubMed  CAS  Google Scholar 

  67. Jackson D, Duthie T. If comparisons can be odious, so can assumptions. Seizure 1996; 5: 247–8

    Article  PubMed  CAS  Google Scholar 

  68. Teeling-Smith G. Epilepsy and health economics. In: Chadwick D, editor. Quality of life and quality of care in epilepsy. London: Royal Society of Medicine, 1990: 32–9

    Google Scholar 

  69. Mauskopf JA, Markowitz MA, Halpern MT, et al. A cost-effectiveness model for estimating the value of Lamictal® (lamotrigine), a new drug for epilepsy treatment [abstract]. Neurology 1996; 46 Suppl. 2: A323

    Google Scholar 

  70. Smith D, Baker G, Davies G. Outcomes of add-on treatment with lamotrigine in partial epilepsy. Epilepsia 1993 Mar–Apr; 34: 312–22

    Article  PubMed  CAS  Google Scholar 

  71. Rossinyol A, Garcia-Mas A, Llinas-Servera J. Changes in the quality of life of epileptic patients treated with lamotrigine [abstract]. Epilepsia 1996; 37 Suppl. 4: 10

    Google Scholar 

  72. Gillham R. Use of SEALS, a quality of life instrument, in evaluating lamotrigine and carbamazepine monotherapy [abstract]. Epilepsia 1995; 36 Suppl. 3: S186

    Google Scholar 

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  1. Adis International Limited, 41 Centorian Drive, Private Bag 65901, Mairangi Bay, Auckland 10, New Zealand

    Heather D. Langtry & Antona J. Wagstaff

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  1. Heather D. Langtry
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Correspondence to Heather D. Langtry.

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Various sections of the manuscript reviewed by: J.A. Armijo, Servicio de Farmacologia Clinica, Hospital Universitario ‘M. de Valdecilla’ and Departamento de Fisiologia y Farmacologia, Facultad de Medicina, Universidad de Cantabria, Santander, Spain; C.E. Begley, School of Public Health, University of Texas at Houston, Houston, Texas, USA; J.W Britton, Neurology, Mayo Clinic, Rochester, Minnesota, USA; E. Perucca, Clinical Pharmacology Unit, Division of Pharmacology and Toxicology, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy; M. Pirmohamed, Prescribing Research Group, Department of Pharmacy and Therapeutics, University of Liverpool, Liverpool, England.

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Langtry, H.D., Wagstaff, A.J. Management of Epilepsy. Dis Manage Health Outcomes 1, 254–270 (1997). https://doi.org/10.2165/00115677-199701050-00004

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