The efficacy of lamotrigine (LTG) in an open, add-on, prospective study of 56 children with refractory generalized epilepsies is reported from British Columbia’s Children’s Hospital, Vancouver, BC, Canada. More than half had a greater than 50% reduction in seizure frequency, six children being seizure-free. Of 15 with Lennox-Gastaut syndrome, 3 were completely controlled and 8 had >50% improvement. Skin rash and an increase in seizure frequency were the most frequent side effects, occurring in 5 and 7 children, respectively. Patients receiving valproate in combination with LTG were most likely to develop rash. LTG was reintroduced alone without recurrence of rash. 
COMMENT. Lamotrigine may be of benefit in children with generalized seizures, including Lennox-Gastaut syndrome. Skin rash may be expected in 10%, especially those receiving higher initial doses of LMG and valproate in combination. The reintroduction of an antiepileptic drug after occurrence of a skin rash is generally contraindicated and potentially hazardous. The present and two previous reports of successful reintroduction of LTG after skin rash are exceptions to the rule. Mimms J et al, Minnesota Epilepsy Group, St Paul, MN, report one of 13 children treated with high dose lamotrigine having an allergic rash at 6 weeks, and a recurrence of rash after reintroduction of LTG. 
Vigabatrin in partial seizures in children decreased seizure frequency by >50% in 70% of patients, and was particularly effective in infants with tuberous sclerosis, in a study at Hopital Saint Vincent de Paul, Paris, France.