Lamotrigine, 5 and 15 mg/kg/daily, was administered as add-on therapy in 37 outpatient children and adolescents with refractory epilepsy and mental delay treated at the Child Neuropsychiatry Unit, Department of Pediatrics, Second University of Naples, Italy. Over a median 7 month trial period, seizures were completely controlled in 22%, and reduced by >50% in 14%. Absence and atonic seizures were controlled more effectively than partial or secondarily generalized seizures. Adverse effects occurred in 16%, but treatment was discontinued only in 1 because of a skin rash. Some improvements in cognition, attention, and speech reported by parents and teachers were unrelated to decrease in seizure frequency. [1]

COMMENT. Lamotrigine is an effective add-on therapy in children with refractory absence, atonic, and tonic-clonic seizures. It is relatively safe and free from serious side-effects. In this series, skin rash developed in 3, but only one required drug withdrawal.

Lamotrigine in pregnancy and lactation was investigated in a patient at the Karolinska Institute and Hospital, Stockholm, Sweden [2]. Plasma levels of lamotrigine (LTG) decreased as pregnancy progressed, suggesting enhanced clearance of LTG. LTG concentrations in the nursing infant (25% of mother’s plasma levels) were high due to passage of LTG into breast milk and slow elimination in the newborn.