Cochrane review of lamotrigine as add-on therapy for drug-resistant focal epilepsy

Takeaway

• In patients with drug-resistant focal epilepsy, addition of lamotrigine to conventional antiepileptic drugs (AEDs) was effective in reducing seizure frequency and was fairly well-tolerated.

Why this matters

• Findings warrant high-quality research to evaluate the long-term efficacy and tolerability of lamotrigine and to compare it with newer AEDs.

Study design

• Updated Cochrane review of 14 randomised controlled trials including 1806 eligible participants (38 infants, 199 children, and 1569 adults).
• Funding: The National Institute for Health Research.

Key results

• Moderate-certainty evidence suggested that lamotrigine vs placebo was significantly more effective in reducing seizure frequency (≥50% reduction; risk ratio [RR], 1.80; 95% CI, 1.45-2.23) and treatment withdrawal because of any reason (RR, 1.11; 95% CI, 0.91-1.37).
• Lamotrigine vs placebo group had a significantly increased risk for adverse events as follows:
  • ataxia (RR, 3.34; 95% CI, 2.01-5.55);
  • dizziness (RR, 2.00; 95% CI, 1.52-2.64);
  • diplopia (RR, 3.79; 95% CI, 2.15-6.68); and
  • nausea (RR, 1.81; 95% CI, 1.22-2.68).

Limitations

• Risk of bias.