Cochrane Database Syst Rev

Lamotrigine as an add-on treatment for drug-resistant focal epilepsy

January 2, 2024

According to this Cochrane Review, lamotrigine as an add-on treatment for drug-resistant focal seizures is probably effective for reducing seizure frequency, although the drug is more likely to lead to adverse effects (eg., ataxia, dizziness) as compared with placebo. There is probably little or no difference in the number of people who withdraw from treatment with lamotrigine versus placebo. In their literature search, reviewers identified no new studies for this update, so the results and conclusions of the review from 2020 remain unchanged.

• Researchers included 14 studies (38 infants, 199 children, 1,569 adults) that investigated add-on lamotrigine versus add-on placebo or no add-on treatment in people of any age with drug-resistant focal epilepsy.
• Primary outcome was 50% or greater reduction in seizure frequency. Secondary outcomes were treatment withdrawal, adverse effects, cognitive effects, and quality of life.
• Lamotrigine compared with placebo probably increases the likelihood of achieving 50% or greater reduction in seizure frequency (RR 1.80, 95% CI 1.45 to 2.23; 12 trials, 1,322 participants (adults and children); moderate-certainty evidence).
• There is probably little or no difference in risk of treatment withdrawal for any reason among people treated with lamotrigine versus people treated with placebo (RR 1.11, 95% CI 0.91 to 1.37; 14 trials; 1,806 participants; moderate-certainty evidence).
• Lamotrigine compared with placebo is probably associated with a greater risk of ataxia (RR 3.34, 99% Cl 2.01 to 5.55; 12 trials; 1,525 participants; moderate-certainty evidence), dizziness (RR 1.76, 99% Cl 1.28 to 2.43; 13 trials; 1,768 participants; moderate-certainty evidence), nausea (RR 1.81, 99% CI 1.22 to 2.68; 12 studies, 1,486 participants; moderate-certainty evidence), and diplopia (RR 3.79, 99% Cl 2.15 to 6.68; 3 trials, 944 participants; moderate-certainty evidence).
• There is probably little or no difference in the risk of fatigue between lamotrigine and placebo (RR 0.82, 99% CI 0.55 to 1.22; 12 studies, 1,552 participants; moderate-certainty evidence).

Source:

Panebianco M, et al. (2023, December 11). Cochrane Database Syst Rev. Lamotrigine add-on therapy for drug-resistant focal epilepsy. https://pubmed.ncbi.nlm.nih.gov/38078494/