Lamotrigine therapy in patients requiring a change in antiepileptic drug regimen.

INTRODUCTION: The tolerability of lamotrigine as adjunctive and monotherapy in patients requiring a change in antiepileptic drug (AED) therapy was assessed in this multicenter, open-label study. Open-label studies conducted in the clinic setting may provide additional drug tolerability and effectiveness information that may not be evident in pre-approval clinical trials. METHODS: Adult patients with partial seizures received adjunctive lamotrigine for 16 weeks. Patients taking a single enzyme-inducing AED could convert to lamotrigine monotherapy for an additional 12 weeks. Patients were assessed at baseline, end of adjunctive therapy, and end of monotherapy using the Liverpool Adverse Experience Profile (AEP), Quality of Life in Epilepsy-31, a patient satisfaction rating, and a subjective investigator global assessment. RESULTS: Of the 547 patients enrolled (mean age 42.7 years, 58% female), 421 (77%) completed adjunctive therapy. Upon completion of the adjunctive phase, mean improvement from baseline was 4.3 points on the AEP, and investigators rated 71% of patients as improved in global status. Overall score on the QOLIE 31 improved by 10 points from baseline. One hundred and seventy-eight patients entered and 143 (80%) patients completed the monotherapy phase. In patients completing lamotrigine monotherapy, mean improvement from baseline was 5.9 points on the AEP, and investigators rated 92% as improved in global status. Overall score on the QOLIE 31 score improved by 15 points from baseline. CONCLUSION: Lamotrigine as adjunctive treatment and monotherapy may improve side effect burden and quality of life in patients requiring a change in AED therapy.     

拉莫三嗪对癫痫患者生活质量影响的研究

目的：评价拉莫三嗪对癫痫患者生活质量的影响。方法：采用多中心、前瞻性的研究方法，对新诊断癫痫患者应用拉莫三嗪治疗，并在基线期及用药6个月后，采用QOLIE-31、MOSSF-36量表、数字符号转换测验、HAMD抑郁量表和女性专用调查问卷对患者进行生活质量评价。结果：共纳入新诊断癫痂患者282例。MOSSF-36量表的8个项目得分在用药后均有显著提高（P〈0．01）；QOLIE-31问卷中“对癫痫的担心”、“情绪”、“活力”、“认知”、“药物不良反应”、“社会功能”及“总体自身健康评价”项目得分在用药后均有显著提高（P〈0．01）。用药后，患者Hamilton抑郁量表平均3．65分，显著低于基线期6．42分（P〈0．01）；数字符号转换测验得分在用药后与基线期比较有显著提高（P〈0．01）。结论：拉莫三嗪初始单药治疗能在一定程度上改善新诊断癫痫患者的生活质量。     

Lamotrigine monotherapy improves health-related quality of life in epilepsy: a double-blind comparison with valproate

The effects of monotherapy with lamotrigine on health-related quality of life were compared with those of valproate monotherapy in a randomized, double-blind trial designed to evaluate treatment-emergent weight changes in patients with epilepsy. At the end of 8 months of treatment, significantly more patients using lamotrigine compared with valproate experienced quality-of-life improvements on the Health Perceptions (42% vs 15%), Energy/Fatigue (47% vs 28%), and Social Isolation (35% vs 16%) subscales of the Quality of Life in Epilepsy-89 (QOLIE-89) questionnaire (P<0.05). Compared with valproate-treated patients, lamotrigine-treated patients were four times more likely to experience improvement in Health Perceptions, 2.3 times more likely to experience improvement in Energy/Fatigue, and 2.8 times more likely to experience improvement in Social Isolation (P<0.05). These quality-of-life improvements are consistent with the improvements in mood measured with the Beck Depression Inventory, the Cornell Dysthymia Rating Scale, and the Profile of Mood States among patients receiving lamotrigine. These data show that lamotrigine monotherapy provides benefits over valproate monotherapy in improving several aspects of health-related quality of life in patients with epilepsy. The observation that quality-of-life improvements during lamotrigine monotherapy occurred concurrently with improvements in mood suggests that the quality-of-life and mood changes may be causally related.     

Drug selection for the newly diagnosed patient: When is a new generation antiepileptic drug indicated?

Abstract. Treatment options in epilepsy have increased dramatically since the early 1990s with the introduction of nine new generation antiepileptic drugs (AEDs) (felbamate, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, tiagabine, topiramate, vigabatrin and zonisamide). This makes drug selection much more complicated and challenging. This review discusses drug selection in patients with newly diagnosed epilepsy and in particular the role of new AEDs in this population. The choice of treatment should always be based on a careful comparison of the risk-benefit ratio for the different treatment options and the outcome of such evaluation may be different in patients with new onset compared with chronic epilepsy. Efficacy, tolerability and safety are the main criteria for selection of AEDs and any first line drug for patients with newly diagnosed epilepsy must have demonstrated satisfactory efficacy as monotherapy in that patient population. So far, of the new AEDs only lamotrigine, oxcarbazepine and topiramate have documentation sufficient to be granted licence for use as monotherapy in most European countries. Because the new generation AEDs have failed to demonstrate improved effectiveness as monotherapy, old generation AEDs such as carbamazepine and valproate remain drugs of first choice for partial and generalised seizures, respectively. However, there are special situations and populations where a new AED may be a reasonable first line drug. These include vigabatrin in West syndrome associated with tuberous sclerosis, lamotrigine as alternative to valproate in idiopathic generalised seizures in women of childbearing potential and lamotrigine for the treatment of epilepsy in the elderly population. The role of the new generation AEDs is likely to become more prominent as more experience is gained.     

Lamotrigine Monotherapy Improves Depressive Symptoms in Epilepsy: A Double-Blind Comparison with Valproate

Depressive symptoms are highly prevalent in patients with epilepsy. The antiepileptic drug lamotrigine has been shown to be an effective treatment for the depressive phase of bipolar disorder and to enhance mood and well-being in epilepsy patients. The effects of lamotrigine monotherapy on depressive symptoms in epilepsy have not been evaluated to date in a controlled clinical trial. A recently completed double-blind epilepsy trial comparing the effects of lamotrigine monotherapy and valproate monotherapy on weight change incorporated a battery of standard mood assessments. Mean screening Beck Depression Inventory scores showed that both lamotrigine and valproate groups suffered from mild depression at baseline. Lamotrigine monotherapy was reliably associated with earlier and larger improvements than valproate in mood assessed with the Beck Depression Inventory, the Cornell Dysthymia Rating Scale, and the Profile of Mood States. Considered in the context of other data showing lamotrigine's antidepressant efficacy in bipolar depression, these results suggest that lamotrigine improves mood in mildly depressed patients with epilepsy. Lamotrigine may be particularly useful in treating epilepsy patients with comorbid depression, the most common psychiatric illness in epilepsy.     

Efficacy and tolerability of conversion to monotherapy with lamotrigine compared with valproate and carbamazepine in patients with epilepsy

OBJECTIVE: This randomized, open-label study was designed to compare the efficacy and tolerability of lamotrigine monotherapy with those of valproate and carbamazepine monotherapy in patients with epilepsy whose seizures were uncontrolled on their prestudy antiepileptic drug monotherapy. METHODS: Patients meeting eligibility criteria were randomized 2:1 to lamotrigine:carbamazepine or lamotrigine:valproate. The treatment phase was divided into a 4-week dose-escalation phase (Weeks 1-4), during which lamotrigine, carbamazepine, or valproate was added to patient's prestudy monotherapy; an 8-week add-on phase (Weeks 5-12), during which patients were stabilized on both the study medication and their prestudy antiepileptic therapy; an 8-week withdrawal phase (Weeks 13-20), during which prestudy antiepileptic therapy could be withdrawn if clinically appropriate; and an 8-week monotherapy phase (Weeks 21-28), during which patients could be treated with study medication as monotherapy. RESULTS: The numbers of patients randomized to the carbamazepine and valproate arms of the study were 144 (98 lamotrigine, 46 carbamazepine) and 158 (105 lamotrigine, 53 valproate), respectively. Successful monotherapy sustained for at least 7 weeks was achieved in comparable percentages of patients in the lamotrigine group (56%) and the carbamazepine group (54%) and in more patients in the lamotrigine group (49%) than the valproate group (40%). Among monotherapy completers, the percentage of patients with zero seizures during the monotherapy phase was comparable for lamotrigine (41%) and carbamazepine (30%) and significantly higher (P<0.05) with lamotrigine (32%) than with valproate (11%). No differences between treatments were observed with respect to time to treatment failure or time to first seizure. Lamotrigine was also better tolerated than carbamazepine or valproate. CONCLUSION: Lamotrigine monotherapy was as effective as and better tolerated than carbamazepine or valproate monotherapy in patients whose seizures were uncontrolled on their prestudy antiepileptic drug monotherapy.     

Lamotrigine: clinical experience in 93 patients with epilepsy

This open study reports the use of lamotrigine in 93 adults and children with drug resistant epilepsy. Lamotrigine was used predominantly as add-on therapy and outcome was assessed by the patient, parents and carers and the physician in terms of reduction of seizure frequency, drug side effects, and importantly with this drug, improvement in quality of life. Twenty five of the 93 patients (26.9%) studied were rendered seizure free with the addition of lamotrigine to their therapy. This was especially the case for patients with complex partial seizures, generalised seizures secondary to brain damage, primary generalised epilepsy and the Lennox Gastaut syndrome. Quality of life improvements were especially striking in patients with seizures secondary to brain damage and in the Lennox Gastaut Syndrome. Twenty eight patients ceased lamotrigine, 13 due to lack of effect and the remainder due to side effects. Lamotrigine is a potentially very useful anti-epileptic medication in persons with complex partial seizures, but also in primary generalised epilepsy, the Lennox Gastaut syndrome and especially in those individuals who have seizures subsequent to brain damage.     

Antikonvulsive Pharmakotherapie Jugendlicher und Erwachsener

In spite of the introduction and improvement especially of epilepsy surgery and also of other treatment options, such as ketogenic diet or neurostimulation, anticonvulsant chronic drug treatment has clearly remained the standard for the vast majority of epilepsy patients. Since 1992 when the first antiepileptic drug (AED) of the newer generation was introduced, a marked increase of seizure freedom among epilepsy patients, which is still the primary goal of treatment, has, however, not been reached. However, some of the new AEDs potentially allow better tolerable long-term treatment due to superior pharmacological characteristics. This might help to address the aspect of chronic AED treatment or comorbidities more efficiently. Hence, tolerability reasons led to a ranking according to the guidelines of the German Neurological Society that recommend lamotrigine and levetiracetam as first-line AEDs in cases of focal epileptogenesis. Special individual needs and considerations may allow and justify other AEDs in certain patients who are labelled for monotherapy. In cases of generalized epileptogenesis in adults valproic acid remains the first-line AED but lamotrigine may be preferred in special circumstances which include aspects such as teratogenicity. Ethosuximide is a first-line AED together with valproic acid followed by lamotrigine. If bilateral convulsive seizures occur primidone and phenobarbital may be considered as third-line AEDs. Several experts prefer levetiracetam although it is labelled only for off-label treatment in juvenile myoclonic epilepsy and not as monotherapy. The latter, however, should remain state of the art, as it more practicable and the easiest to assess concerning effectiveness. If treatment fails in spite of a correct diagnosis and classification an alternative monotherapy should be considered although a variety of publications have indicated that in the era of new AEDs combinations may be necessary to achieve sustained freedom of seizures. Thus the necessity to obtain alternative monotherapies should probably be expressed less dogmatically than currently published in the guidelines. Combinations should be as simple as possible and be comprehensible concerning the individual impact of the combination partners. High efficacy, lack of interactions and good tolerability have made levetiracetam to the most important add-on drug beyond the well-established and supra-additive combination of valproic acid and lamotrigine. Further investigations must be carried out on whether the latest new AEDs lacosamide, retigabine and perampanel all offer new modes of action with benefits for patients and opening the door to a more rational polytherapy in epilepsy treatment. Currently similar efficacy suggests that the risk of clinically relevant interactions and tolerability is the most important factor when choosing the appropriate add-on drug. Discontinuation may be considered only after freedom of seizures for many years and the prognosis is most favorable when the major causative factor no longer exists or has been eliminated.     

The relationship between treatment with valproate, lamotrigine, and topiramate and the prognosis of the idiopathic generalised epilepsies

OBJECTIVE: To examine a large population with idiopathic generalised epilepsy (IGE), and estimate the overall remission rates for the IGEs and subsyndromes in a clinic based sample. Remission rates on valproate, lamotrigine, topiramate, and combinations of these antiepileptic drugs were estimated and factors predicting outcome examined. METHODS: All patients with IGE were identified from a computerised database and EEG records at large adult and paediatric epilepsy clinics. Data were recorded retrospectively on demographics and clinical information, seizure types and syndrome diagnosis, antiepileptic drug treatment details, and remission rates. RESULTS: 54.3% of 962 patients had achieved a one year period of remission; this was most likely with valproate monotherapy (52.1%), with lower rates for lamotrigine and topiramate (16.7% and 34.6%, respectively). The combination of valproate and lamotrigine achieved a remission rate of 15.3%. The factor most predictive of a response to a particular antiepileptic drug regimen was the rank order in which it was given. Relapse rate was high (79.9%) after antiepileptic drug withdrawal in remission, particularly with juvenile myoclonic epilepsy (93.6%). CONCLUSIONS: Valproate may be the most effective antiepileptic drug in the treatment of the IGEs. Combination therapy should be initiated if an adequate trial of valproate monotherapy is not effective, rather than switching to alternative monotherapy. Antiepileptic drug treatment needs to be lifelong in many adult patients with IGE.     

Lamotrigine monotherapy compared with carbamazepine, phenytoin, or valproate monotherapy in patients with epilepsy

OBJECTIVE: This open-label study evaluated the efficacy and tolerability of lamotrigine monotherapy compared with monotherapy with conventional antiepileptic drugs in patients converting from previous monotherapy because of inadequate seizure control or unacceptable side effects. METHODS: This study was conducted in 26 neurology clinics and epilepsy centers throughout the United States. The study enrolled 115 patients with epilepsy converting from previous monotherapy because of inadequate seizure control or unacceptable side effects. Patients were randomized 1:1 to receive 24 weeks of lamotrigine monotherapy or monotherapy with a conventional antiepileptic drug (carbamazepine, phenytoin, or valproate based on physician's choice). Patients were converted during an 相似文献   

Effect of lamotrigine on sexual function in patients with epilepsy.

OBJECTIVE: To assess the course of sexual function in epilepsy patients treated with lamotrigine. MATERIAL AND METHODS: This open study included 141 patients treated with lamotrigine for a period of 8 months: 79 patients initiated treatment with lamotrigine monotherapy, and 62 were switched to lamotrigine because of lack of efficacy or adverse events to a previous antiepileptic drug (AED). Patients were assessed at baseline and after 4 and 8 months of treatment. In the baseline and final visits the Changes in Sexual Functioning Questionnaire (CSFQ) was applied. Analysis was performed in an intent-to-treat population. RESULTS: In women who started treatment with lamotrigine, a significant improvement was observed, both in total CSFQ score (increase of 5.39 +/- 6.95 points; p < 0.05), and in the five dimensions of the scale (desire/frequency, desire/interest, pleasure, arousal/excitement and orgasm). In men, a significant improvement was only observed in the pleasure dimension. In the group of patients in whom a previous AED was substituted by lamotrigine, significant improvement was recorded in the dimensions of pleasure and orgasm in men and desire/frequency in women, whilst in women the desire/interest dimension showed a decrease. CONCLUSIONS: In this observational study, an improvement in sexual dysfunction was observed in association with lamotrigine. This could have been the result of improvement of the epilepsy, changes in quality of life, elimination of side effects from other AEDs, or a mood-stabilizing effect of lamotrigine.     

Higher androgens and weight gain with valproate compared with lamotrigine for epilepsy

BACKGROUND: Valproate is used widely for the treatment of epilepsy but has been associated with hyperandrogenism, hyperinsulinemia, and dyslipidemia. The mechanism for these associations is unknown, but they have been hypothesized to be secondary to valproate-associated weight gain. This study was conducted to test the hypothesis that the antiepileptic drug lamotrigine, which also has a broad spectrum of anti-seizure efficacy, would not be associated with endocrine abnormalities and would not cause weight gain. OBJECTIVE AND METHODS: This open-label, cross-sectional study compared (1) endocrine and lipid measures during the early follicular phase of the menstrual cycle; (2) prevalence of menstrual disorders (from patient diaries recorded over three cycles); and (3) body weight of women with epilepsy on lamotrigine monotherapy (n=119) with those on valproate monotherapy (n=103) for <5 years. RESULTS: Mean total serum testosterone and androstenedione levels were higher (P<0.02) in the valproate group compared with the lamotrigine group. More lamotrigine patients (87%) than valproate patients (77%) reported regular menstrual cycles at the Screening Visit. The prevalence of anovulation did not differ between lamotrigine and valproate. Mean HDL cholesterol levels were higher (P<0.01) with lamotrigine compared with valproate as were LDL and total cholesterol levels (P<0.05). Mean total insulin levels did not significantly differ between the groups. Whereas mean body weight in lamotrigine patients did not differ between the time lamotrigine treatment was initiated and the Study Visit, mean weight in valproate patients increased by 3.7 kg. CONCLUSIONS: Compared with lamotrigine monotherapy, valproate monotherapy was associated with weight gain and higher androgen levels in women with epilepsy. These data suggest that the hyperandrogenism observed in some women using valproate for epilepsy may be secondary to drug therapy. Lamotrigine monotherapy may be more appropriate than valproate for women in whom reproductive endocrine or metabolic abnormalities are potential concerns, i.e. women with concerns about weight gain, diabetes, hirsutism, polycystic ovary syndrome, menstrual dysfunction or infertility.     

New observations in primary and secondary reading epilepsy: excellent response to levetiracetam and early spontaneous remission

The response of reading epilepsy to new antiepileptic drugs is not known. Due to the rarity of this condition little is known about its natural history. We evaluated and treated three patients with primary and secondary reading epilepsy. Seizures in all patients were characterized by twitching of the jaw or lips with secondarily generalized tonic-clonic seizures if reading continued. One patient with primary reading epilepsy became seizure-free with divalproex monotherapy and another with levetiracetam monotherapy after failure of lamotrigine. One other patient with secondary reading epilepsy became seizure-free with levetiracetam add-on therapy. The divalproex-treated patient stopped therapy less than 3 years after seizure onset and remained seizure-free with 6 years of follow-up. We propose levetiracetam as a first-line treatment for primary and secondary reading epilepsy. Spontaneous medication-free remission of primary reading epilepsy may occur within 3 years of seizure onset, much earlier than previously reported.     

Valproate and Lamotrigine in Pediatric Patients With Refractory Epilepsy: After the First Year

The combination of lamotrigine and valproate/divalproex sodium has been shown to be effective in the treatment of refractory epilepsy. This study aims to evaluate the pharmacologic properties of using this combination in a pediatric population refractory to antiepileptic drugs, with an extended follow-up. We studied a group of 51 patients, ranging from 4 to 16 years of age. Sixteen patients (31.4%) had generalized epilepsy and 35 (69.6%) had focal epilepsy. The combination was effective in 39 patients (76.5%) in the first year of follow-up and in 36 patients (70.6%) in the second year, with a reduction in drop attacks observed in 22 (88.5%). Adverse effects included rash, leading to discontinuation in four patients (7.8%). Slower introduction of lamotrigine minimizes adverse effects, thereby improving quality of life and adherence to treatment. In addition, therapeutic efficacy is maintained with lower doses of lamotrigine, even after the first year of treatment.     

Epilepsy treatment in Rett syndrome

Rett syndrome is a neurodevelopmental disorder predominately affecting females. The majority of patients have epilepsy in the early stages of the disease. This study evaluates the clinical course of epilepsy and the effect of antiepileptic drug treatment in Rett syndrome using retrospective data analysis. Epilepsy was present in 16 of 19 (84%) patients with Rett syndrome in this series. The mean age of seizure onset was 4 years. Remission of seizures was achieved after the first monotherapy in 56% and after the second monotherapy in 18.5% of patients. Valproate, lamotrigine, and carbamazepine were the drugs used most frequently as monotherapy. Valproate monotherapy was highly effective as 75% of treated patients achieved seizure remission. Monotherapy with lamotrigine or carbamazepine was effective in half of the treated patients. There was a clear tendency toward seizure remission after the age of 15 years.     

Treatment of epilepsy in adults: expert opinion in China

ObjectiveThe goal of this study was to survey a group of epileptologists in China regarding the treatment of adult epilepsy.MethodsA questionnaire on treatment of adult epilepsy was sent to a group of opinion leaders in the field of epilepsy.ResultsFor initial monotherapy for idiopathic generalized epilepsy (IGE), valproate was rated as the treatment of choice. In symptomatic localization-related epilepsy (SLRE)/simple partial seizures and SLRE/complex partial seizures, carbamazepine and oxcarbazepine were the respective treatments of choice, whereas in SLRE/secondarily generalized tonic–clonic seizures, carbamazepine, lamotrigine, and oxcarbazepine were treatments of choice. For women who were pregnant or trying to conceive, lamotrigine was the treatment of choice for both IGE and SLRE. In people with epilepsy who were HBsAg positive, whether liver function was normal or not, topiramate and levetiracetam were treatments of choice for IGE. Valproate and levetiracetam were treatments of choice for seizures in the emergency department.ConclusionA high level of consensus was reached on most treatments of choice and first-line treatments for patients with epilepsy, which were in accordance with published US expert opinion.     

Cognitive effects of lamotrigine as first-line add-on in patients with localization-related (partial) epilepsy

The objective of this study is to explore clinically relevant central cognitive side effects of lamotrigine (LMT) in patients with localization-related (partial) epilepsy. Attentional processes, short-term memory, and speed factors (motor and mental speed) were investigated in an open-label first-line add-on clinical nonrandomized study with carbamazepine (Tegretol-CR) as baseline medication. Twenty-five patients were assessed at baseline (monotherapy carbamazepine) and after 5 months of add-on treatment with lamotrigine. During this 5 month period, the baseline medication was unchanged. Evidence supported the hypothesis that the cognitive profile of lamotrigine is similar to that of carbamazepine. None of the test scores showed a statistically significant decrease after adding lamotrigine, and most of the changes were in the positive direction. The most marked change was that patients showed fewer complaints after 5 months of add-on treatment with lamotrigine.     

Treatment of pediatric epilepsy: European expert opinion, 2007.

BACKGROUND: Childhood epilepsies are a heterogeneous group of conditions that differ in diagnostic criteria and management and have dramatically different outcomes. Despite increasing data on treatment of epilepsy, research findings on childhood epilepsy are more limited and many clinical questions remain unanswered, so that clinicians must often rely on clinical judgment. In such clinical situations, expert opinion can be especially helpful. METHODS: A survey on pediatric epilepsy and seizures (33 questions and approximately 650 treatment options) was sent to 57 European physicians specializing in pediatric epilepsy, 42 (74%) of whom completed it. In some questions, the experts were asked to recommend overall treatment approaches for specific syndromes (the order in which they would use certain strategies). Most of the questions asked the experts to rate options using a modified version of the RAND 9-point scale for medical appropriateness. Consensus was defined as a non-random distribution of scores by chi-square test, with ratings used to assign a categorical rank (first line/usually appropriate, second line/equivocal, and third line/usually not appropriate) to each option. RESULTS: Valproate was treatment of choice for symptomatic myoclonic and generalized tonic-clonic seizures. For initial monotherapy for complex partial seizures, carbamazepine and oxcarbazepine were treatments of choice, with valproate also first line. As initial therapy for infantile spasms caused by tuberous sclerosis, viagabatrin was treatment of choice. As initial therapy for infantile spasms that are symptomatic in etiology, vigabatrin was also treatment of choice, with adrenocorticotropic hormone (ACTH) and prednisone other first-line options. As initial therapy for Lennox-Gastaut syndrome, valproate was treatment of choice. For acute treatment of a prolonged febrile seizure or cluster of seizures, rectal diazepam was treatment of choice. Valproate was treatment of choice as preventive therapy for febrile seizures. For benign childhood epilepsy with centro-temporal spikes, valproate was treatment of choice. For childhood and juvenile absence epilepsy, valproate was treatment of choice, with lamotrigine another first-line option (ethosuximide was another first-line option for childhood absence epilepsy). For juvenile myoclonic epilepsy in adolescent males, valproate was treatment of choice, with lamotrigine another first-line option; for juvenile myoclonic epilepsy in adolescent females, lamotrigine was treatment of choice, with valproate another firstline option. As initial therapy for neonatal status epilepticus, intravenous (IV) phenobarbital was treatment of choice. As initial therapy for all types of pediatric status epilepticus, IV diazepam was treatment of choice. For generalized tonic-clonic status epilepticus, rectal diazepam and IV lorazepam were also treatments of choice; for complex partial status epilepticus, IV lorazepam was another first-line option. CONCLUSION: The expert panel reached consensus on many treatment options. Within the limits of expert opinion and with the understanding that new research data may take precedence, the experts' recommendations provide helpful guidance in situations where the medical literature is scant or lacking. The information in this report should be evaluated in conjunction with evidence-based findings.     

Lamotrigine in patients with epilepsy and comorbid depressive symptoms

PurposeThis open-label study evaluated the antidepressant qualities of lamotrigine (LTG) in people with epilepsy.MethodsEligible patients exhibited low to moderate depressive symptoms and required a change in antiepileptic drug (AED) therapy, but were excluded if they had a major depressive disorder (MDD). Lamotrigine was added onto a stable AED regimen, and self-report instruments were administered to evaluate changes in mood states. Evaluations were conducted at baseline, at the end of 19 weeks of adjunctive treatment, and 36 weeks following conversion to monotherapy.ResultsOne hundred and fifty-eight patients with epilepsy participated; 96 patients completed adjunctive treatment, and 66 patients completed monotherapy. Intent-to-treat analyses for all instruments showed improvement in depression scores after adjunctive LTG treatment. Improvement was maintained for those converted to monotherapy.ConclusionsThese data suggest that LTG may have antidepressant activity for patients with epilepsy and comorbid low to moderate depressive symptoms, and warrant a randomized controlled trial for validation.     

Effectiveness of maintenance therapy of lithium vs other mood stabilizers in monotherapy and in combinations: a systematic review of evidence from observational studies

Objectives

For the first time to present a systematic review of observational studies on the efficiency of lithium monotherapy in comparison with other maintenance mood stabilizers in monotherapy and in combination.

Methods

As part of the International Society for Bipolar Disorders (ISBD) Task Force on Lithium Treatment, we undertook a systematic literature search of non‐randomized controlled observational studies on (i) lithium monotherapy vs treatment with another maintenance mood stabilizer in monotherapy and (ii) lithium in combination with other mood stabilizers vs monotherapy.

Results

In eight out of nine identified studies including a total of < 14 000 patients, maintenance lithium monotherapy was associated with improved outcome compared with another mood stabilizer in monotherapy, including valproate, lamotrigine, olanzapine, quetiapine, unspecified anticonvulsants, carbamazepine/lamotrigine, unspecified atypical antipsychotics and unspecified antipsychotics. Among the four identified studies including a total of > 4000 patients comparing maintenance combination therapy with maintenance monotherapy, a few combination therapies were found to be superior to monotherapy in some analyses, but many were not.

Conclusions

The results show the superiority in real life of lithium monotherapy compared with monotherapy with other maintenance mood stabilizers. The four largest register‐based studies largely addressed confounding, but, as ever, residual confounding cannot be excluded. Nevertheless, the observational findings substantially add to the findings from randomized controlled trials, whose designs often limit the validity of comparison between medicines.