Neil Buchanan

The use of lamotrigine in juvenile myoclonic epilepsy

Lamotrigine (LTG) was used in 12 patients with juvenile myoclonic epilepsy (JME) who either had sodium valproate (VPA) side effects or did not wish to take VPA. Five patients are now fully controlled on LTG monotherapy. Side-effects were corrected by VPA withdrawal or reduction except for severe weight gain. In three patients it was not possible to withdraw VPA due to the re-emergence of myoclonus, suggesting LTG-VPA synergism. Two patients had successful pregnancies whilst taking LTG. Lamotrigine is a useful alternative in the management of JME.

Epilepsy: patient perceptions of their condition

The objective of this study was to ascertain the perceptions of people with epilepsy about their condition. Nine hundred and eight questionnaires were sent to members of epilepsy associations, with a 45% response rate, and 625 questionnaires were sent to neurologists for their patients to complete, with a response rate of 16.5%. The results reinforce and extend previous observations that there is an ongoing need for educating health care professionals and persons with epilepsy about the condition. Matters pertaining to driving, the unpredictability of seizures, lack of employment and cognitive difficulties were of major concern to the respondents. The present data also highlighted the vexed relationship between stress and seizure control, which needs to be further investigated. These data should be of value to doctors and other health care professionals in their dealings with people with epilepsy. It should also provide epilepsy associations with data upon which they might be able to plan education services.

The efficacy of lamotrigine on seizure control in 34 children, adolescents and young adults with intellectual and physical disability

This study reports the use of lamotrigine, largely as add-on therapy, in 34 children, adolescents and adults with brain damage and resistant seizures. Seventy-four percent of the patients showed a greater than 50% improvement in seizure control with 35% becoming seizure free. This improvement in seizure control was associated with an enhanced quality of life in 65% of the patients as assessed by improved alertness, mobility, speech and independence. It was possible to reduce 36% of the pre-existing antiepileptic drugs and the side effect profile of lamotrigine was very good. It is proposed that lamotrigine may be a particularly useful antiepileptic drug in this particular group of patients.

Noncompliance with medication amongst persons attending a tertiary referral epilepsy clinic: implications, management and outcome

The present report looks at the nature, management and outcome of episodes of noncompliance with antiepileptic medication in 42 patients attending a tertiary referral epilepsy clinic with noncompliance being ascertained by patient admission. The main causes of noncompliance were forgetfulness, a refusal to take medication and a patient perception that their epilepsy was not severe enough to warrant medication. Management consisted of individual patient discussion, frequently on recurrent occasions. As far as outcome was concerned, 20 patients had no further episodes of noncompliance during the period of follow-up, five came off medication altogether and remain seizure-free, three improved but have lapses and in nine patients it was not possible to effect any change. Overall, individual patient management was helpful and worthwhile.

The occurrence, management and outcome of antiepileptic drug side effects in 767 patients.

This study reports the nature of adverse drug reactions (ADR) occurring in 767 epilepsy clinic patients (adults and children), the drugs most commonly involved, how they were managed and the outcome of such management. One hundred and thirty four patients were found to have 155 separate ADRs. The majority appeared to be pharmacodynamic in nature, although 21 were clearly pharmacokinetic in origin and four due to drug interactions. The antiepileptic drugs (AED) perceived to be causative, in order of frequency were phenytoin, sodium valproate, carbamazepine, clonazepam, barbiturates, vigabatrin and clobazam. Management most often involved withdrawing the offending drug(s), usually replacing them with another AED. Of the 155 ADRs, 40.6% resolved totally, 27.7% showed a marked improvement, 16.1% improved, 14.8% did not change and one patient deteriorated. This study emphasizes the need to be vigilant for ADRs and demonstrates that their management is essentially clinical with some 85% of patients experiencing benefit.

Clonazepam withdrawal in 13 patients with active epilepsy and drug side effects

We report the end result of clonazepam (CZP) withdrawal in 13 patients with significant side effects felt to be due to CZP. The present observations supplement the recent report in Seizure by Chataway et al., in proposing a safe CZP withdrawal rate of 0.2 mg/day. Eight of the patients had withdrawal seizures, five had withdrawal symptoms and four patients had no withdrawal problems at all. Ultimately all the patients came off CZP, mainly quite rapidly (3-30 days) with the initial side effects regressing totally in 11 patients.

Social aspects of epilepsy in childhood and adolescence

Epilepsy differs from other chronic conditions because of the unpredictability of the seizures, the absence of an absolute diagnostic test other than video-telemetry and the stigma associated with the condition. Working from a hospital base with a biased population, one might be forgiven for thinking that most people with epilepsy have major problems either of seizure control or socially. This is naturally not the case, but the social problems of epilepsy are sufficiently frequent and/or severe to warrant comment. Simply making the diagnosis may produce parental anxiety and guilt. This is often compounded by societal misunderstanding of epilepsy and the incorrect association with mental illness. Furthermore, it is those children or adults who have severe epilepsy who stand out in society, with the tacit implication that all epileptics (people with epilepsy) are like them. There is a societal generalization that all epileptics are the same. It is not appreciated that there are many types of epilepsy (convulsive and non-convulsive) and that epilepsy varies from being very mild to intractable. Treatment also has implications: children and adolescents may not like to take, or be seen to be taking, medication. It is desirable where possible to recommend twice daily dosage with breakfast and dinner. This avoids the need to take medication to school, or in the case of adolescents, to work. In addition, compliance is enhanced with a twice daily dosage. There is without doubt a stigma associated with epilepsy which persists despite being to a less degree than in the past.(ABSTRACT TRUNCATED AT 250 WORDS)

Epilepsy and learning

It has long been appreciated that some patients with epilepsy, both children and adults, have cognitive and learning problems. This has become an area of quite intensive investigation over the past 15 years and is associated with a burgeoning literature which presents quite diverse views. In this annotation the relevant literature is summarized and interpreted in the context of management of children with epilepsy.

Epilepsy as an educational model

This paper proposes that epilesy, rather than being seen as educational appendage, squeezed into the curriculum, could profitably serve as a holistic educational model for undergraduate medical students, general practitioner trainees and other health professionals. This proposal is based on considerable experience by both authors in dealing with persons with epilepsy, both adults and children. During this time, a number of factors have become apparent:

Lamotrigine after corpus callosotomy

Corpus callosotomy (CC) has been employed in the management of intractable epilepsy since 1940’ and should be considered for patients with generalized falling seizures with physical injury, recurrent life-threatening generalized convulsive status epilepticus or atypical absence status’. CC is especially useful in improving seizure control in patients with tonic and atonic seizures3 and those with a frontal lobe focus’. Tonic seizures are often resistant to standard medical therapy, but there have been a number of reports of the efficacy of lamotrigine (LTG) in this seizure type5-‘. The present report is of five patients who received lamotrigine following a partial or total CC.