The effectiveness and safety of lamotrigine (Lamictal) monotherapy in newly diagnosed typical absence seizures in 45 children and adolescents, aged 3-15 years, were evaluated in a placebo-controlled, double-blind trial at centers in Norfolk, VA; Akron, OH; Boston, MA; and Research Triangle Park, NC. EEG with hyperventilation and ambulatory 24-hr EEG recordings were used to confirm diagnoses and assess freedom from seizures. In the initial open-label dose escalation phase, 71% of patients (intent-to-treat) or 82% (per protocol analysis) became seizure free on doses of 2-15 mg/kg/day (median, 5.0). In the controlled trial, 62% of patients remained seizure free when treated with LTG and 21% when receiving placebo (p<0.02). Mean plasma LTG concentrations showed a linear relation to the dose. Adverse effects included rash, nystagmus, and depression, but none was severe. Pre-treatment inattention and hyperactivity in 3 patients were improved following LTG. [1]
COMMENT. Lamotrigine monotherapy is effective and relatively free from serious side effects in children with typical absence seizures. Skin rash can be troublesome, but risk of serious rash may be lessened by adhering to recommended dosage guide-lines.