Lamotrigine serum levels: Ceiling effect in people with epilepsy in remission?

Details

Serval ID
serval:BIB_6DCB03FAD153
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Lamotrigine serum levels: Ceiling effect in people with epilepsy in remission?
Journal
Epilepsy & behavior
Author(s)
D'Anto J., Wnuk W., Rossetti A.O., Decosterd L.A., Buclin T., Novy J.
ISSN
1525-5069 (Electronic)
ISSN-L
1525-5050
Publication state
Published
Issued date
09/2017
Peer-reviewed
Oui
Volume
74
Pages
41-44
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Antiepileptic drug titration in epilepsy remains mostly empirical. Since in practice seizure remission may be obtained with low doses, we aimed to determine whether patients in remission have lower lamotrigine levels than those with ongoing seizures.
Retrospective comparison of the distribution of lamotrigine levels among unselected patients in remission and with ongoing seizures. Remission was defined as 3 times the longuest interseizure interval and at least one year. Only trough levels were analyzed.
Between 2009 and 2014, we identified 93 adults, among whom 10 were in remission. Patients in remission had significantly (p=0.008) lower serum levels (median 2.3mg/L, range: 0.7-8.2) than those with ongoing seizures (median 5.4mg/L, range: 1.1-18.2). We did not find any patient in remission with levels higher than 8.2mg/L. Distribution of dosages also differed among the groups, but less significantly (median: 175 vs 300mg, p=0.03).
An association between lamotrigine serum levels and seizure response can be observed. This suggests the existence of a ceiling level, above which remission is unlikely and should prompt antiepileptic medication switch rather than further up-titration of lamotrigine in drug-naïve patients with epilepsy.

Keywords
Adolescent, Adult, Aged, Aged, 80 and over, Anticonvulsants/blood, Anticonvulsants/therapeutic use, Diagnostic Tests, Routine, Epilepsy/blood, Epilepsy/drug therapy, Female, Humans, Male, Middle Aged, Remission Induction/methods, Retrospective Studies, Triazines/blood, Triazines/therapeutic use, Young Adult, Drug naïve, Response to medication, Therapeutic drug monitoring
Pubmed
Web of science
Open Access
Yes
Create date
04/08/2017 13:01
Last modification date
20/08/2019 14:27
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