| چکیده انگلیسی مقاله |
Background: Epilepsy is a common neurologic disorder affecting about 1% of the population (1). The prevalence of active epilepsy in Kerman is 7.87/1000 populations (2). In 23 countries of Asia the rate of epilepsy is the same as USA and Europe. Pharmacotherapy with antiepileptic drugs is the major treatment modality for epilepsy, this could occur as a result of decreased excitation concurrent with increased inhibition (3). Management of epilepsy differs from the treatment of other chronic diseases in which a single breakthrough event has a major negative effect on the quality of life. The past decade has brought many advances to the treatment of epilepsy, including many new pharmacological agents. Lamotrigine is one of the new antiepileptic drugs, which has been used more than two decades. Lamotrigine is effective in partial-onset and secondarily generalized tonic-clonic seizures, primary generalized seizures (i.e., absence seizures and primary generalized tonic-clonic seizures), atypical absence seizures, tonic / atonic seizures and Lennox-Gaustaut syndrome. It is sometimes effective for myoclonic seizures but it can worsen myoclonic seizures in some patients with juvenile myoclonic epilepsy or myoclonic epilepsy of infancy. One of the main advantages of lamotrigine is that it causes less cognitive impairment or overt sedation compared with other treatments (4). An anti-aging effect on animal model in a study has found that lamotrigine decreases mortality and increases lifespan. Lamotrigine has many side effects; the most important ones are allergic reactions, Introducing lamotrigine gradually is one of the keys to reduce the frequency and severity of allergic reactions. Although the incidence of cutaneous reactions to lamotrigine is high, the incidence of serious eruptions such as erythema multiform, Stevens-Johnson syndrome, and toxic epidermal necrolysis is low (5). In this study we evaluated the effects of lamotrigine on epileptic patients. Methods: All epileptic patients who referred to our clinic were evaluated. We started with low dose (25-50mg/day) lamotrigine and gradually increased dosage until the patients became free seizure or adverse events appeared. At first we used lamotrigine once daily, but for patients who needed more than 150 mg/day, we used twice a day. The patients must be at least 6 months free seizure to be in control group. The patients involved by the side effects of the drug, the treatment discontinued. The patients who had other diseases rather than neurological disorders were omitted. Before starting the drug, we had done laboratory exams about white blood count, blood sugar, urea, and calcium. If any abnormality was seen, we omitted these patients too. We had done brain MRI scan and electroencephalogram for all the patients before starting the drug and repeating it every 3 or 6 months. The patients who had normal electroencephalograms were also omitted. Results : 905 epileptic patients went under treatment by lamotrigine (male=502, female=403). 505 persons of them (male=282, female=223) corporate till the end of the study (at least 6 months, but more of them used it more than 2 years. The rate of free seizure is 63.5% in mono therapy (Male=61.6%, Female=64%) in females the rate of free seizure is more than males (PV>0.01), the patients who needed combined therapy by sodium valproate were 107, the rate of free seizure is about 60% (male=45%, female=77.5%), but generally this rate is 16 %. The rate of efficacy in different types of epilepsy (monotherapy & combined with sodium valproate) ; primary generalized tonic-clonic epilepsy more than 88%, secondary generalized tonic-clonic epilepsy 71%, complex partial epilepsy (non tonic-clonic) 72%, and juvenile myoclonic epilepsy 81.5 %. Lamotrigine (monotherapy or combined therapy) effected on 96.7% of familial epileptic patients, and the patients with known focal lesions is 94%. Dosage of lamotrigine used in epileptic patients who had been free seizure is 100-450 mg/day, but mean dosage is 150-200 mg/day, in men this dosage is higher than women , but it was non-significant difference. Used Lamotrigine dosage in this study is lower than other reports. The major adverse events that caused us to discontinue lamotrigine in our study were (n=905): cutaneous reactions were seen in 29 cases (>3%); two of the cases had Steven Johnson syndrome, 9 of them had severe headache (1%), myoclonic jerk exaggerated or induced in 7 cases (0.8%), thrombocytopenia with leucopenia in 3 cases, and dopa-responsive dystonia in 2 cases were seen. We didn’t have any mortality about these adverse events. The minor adverse events were; dizziness, mild diplopia, dry mouth, and mild headache, but we didn’t discontinue the treatment. Conclusion: We recommend using lamotrigine as first choice on secondary and primary generalized epilepsy and even juvenile myoclonic epilepsy, because of tolerability, and fewer adverse events of it. It’s also better because we can prescribe it once or twice per day. |
