Lamotrigine

Abstract

Cough: case report A 26-year-old woman developed cough during treatment with lamotrigine for epilepsy, focal seizures. The woman presented on 18 February 2019 with a 22-year history of paroxysmal bilateral limb convulsions accompanied by unconsciousness. Anamnesis showed that she was diagnosed with hypocalcaemia convulsions in childhood and was given symptomatic treatment; however, the treatment was ineffective. Thereafter, she was treated with phenobarbital and piracetam [Naofukang]; however, the symptoms failed to improve. Subsequently, these drugs were discontinued at the age of 3 years based on her family’s discretion. She had episodes of hallucinations, saw rainbow-like object and talked on her own; however, the symptoms relieved each time after lasting several minutes each time. In 2018, she first saw the rainbow-like object and had stomach discomfort, followed by generalised tonic-clonic seizures. In February 2019, she was diagnosed with epilepsy, focal seizures. She was treated with levetiracetam and oxcarbazepine. In 2020, her visual symptom significantly increased (once every 2–3 days). Therefore, she was treated with oral lamotrigine at an initial dose of 12.5 mg/day. However, on the day of administration, she developed cough with yellow sticky phlegm and frequent cough during the daytime and night. Initially, it was considered cold and cough and was treated with cold medicine with poor response. Therefore, she visited a local hospital. Laboratory tests revealed the following WBC count 5.48 × 109/L, RBC count 4.81 × 1012/L, eosinophil percentage 4.90%, absolute eosinophils count 0.06 × 109/L, basophilic granulocytes percentage 1.10%. A chest CT scan revealed ground-glass opacity in the lower lobe of the left lung suggesting possible infection in the basal segment of the lower lobe of left lung. Based on the findings, a differential diagnosis of pulmonary inflammation was initially considered. The woman was treated with cefixime; however, the symptoms persisted. She experienced severe cough at day and night, which further affected her night sleep. Therefore, she was treated with IV drip of cefixime for 11 days; however, she still had daily cough. Considering the medical history, it was considered that the cough was secondary to lamotrigine. Her lamotrigine was discontinued. Thereafter, she did not have the symptom of cough. After 1 week, she presented again with symptoms of epilepsy. She was treated with lamotrigine at an initial dose of 12.5 mg/day. She was instructed regarding recurrence of cough. However, after lamotrigine initiation, she presented again with symptoms of cough. The symptoms were similar to the last time. She undergone similar investigations. Her cough symptoms were attributed to lamotrigine. Lamotrigine was discontinued immediately, resulting in disappearance of the symptoms of cough. After 2 weeks, routine blood work revealed improved findings. After 1 month, chest CT and routine blood work revealed normal results.