Zusammenfassung
Lamotrigin (Handelsname Lamictal®) hat sich aufgrund einer Reihe positiver kontrollierter
Studien und umfangreicher klinischer Erfahrungen als Monotherapie zur Erstbehandlung
fokaler Epilepsien durchgesetzt und ersetzt vorteilhaft ältere Antiepileptika, vor
allem weil es bei ähnlicher Wirksamkeit weniger müde macht. Treten unter älteren Antiepileptika
Beschwerden auf oder können die Anfälle nicht zufriedenstellend behandelt werden,
ist ein Wechsel auf Lamotrigin vorteilhaft. Auch können Absenzen wirksam behandelt
werden. Lamotrigin führt nicht zu einer Gewichtszunahme und wirkt stimmungsausgleichend.
Die Lamotrigin-Monotherapie ist besser verträglich als eine Kombinationstherapie,
weil weniger Überempfindlichkeitsreaktionen und keine Interaktionen mit anderen Antiepileptika
auftreten.
Abstract
Lamotrigine (Lamictal®) has become a first-line antiepileptic drug for the treatment
of partial epilepsies based on a number of positive comparative trials and widespread
clinical observations. It can favourably replace older antiepileptic drugs because
it is similarly effective while being less sedative. Substitution of older antiepileptic
drugs through a conversion to lamotrigine is advantageous for many patients with side
effects or insufficient seizure control. Absence seizures can effectively be treated
with lamotrigine. A stable body weight during lamotrigine treatment and its antidepressant
effects are welcome. Fewer hypersensitivity reactions and the absence of drug interactions
make single drug treatment with lamotrigine better tolerated and thus preferable over
combination therapy.
Literatur
1 Schmidt D, Elger C E. Praktische Epilepsiebehandlung, 2. Auflage. Stuttgart, New
York; Thieme 2002
2
Brodie M J, Richens A, Yuen A W.
Double-blind comparison of lamotrigine and carbamazepine in newly diagnosed epilepsy.
Lancet.
1995;
345
476-479
3
Steiner T J, Dellaportas C I, Findley L J. et al .
Lamotrigine monotherapy in newly diagnosed untreated epilepsy: A double-blind comparison
with phenytoin.
Epilepsia.
1999;
40
607-610
4
Brodie M J, Anhut H, Murray G, Maton S.
Gabapentin versus lamotrigine monotherapy: a double-blind comparison (abstract).
Epilepsia.
2000;
41 (Suppl Florence)
138-139
5
Reunanen M, Dam M, Yuen A W.
A randomized open multicentre comparative trial of lamotrigine and carbamazepine as
monotherapy in patients with newly diagnosed or recurrent epilepsy.
Epilepsy Res.
1996;
23
149-155
6
Nieto-Barrera M, Brozmanova M, Capovilla G. et al .
A comparison of monotherapy with lamotrigine or carbamazepine in patients with newly
diagnosed partial epilepsy.
Epilepsy Res.
2001;
46
145-155
7
Brodie M J, Overstall P W, Giorgi L.
Multicentre, double-blind, randomized comparison between lamotrigine and carbamazepine
in elderly patients with newly diagnosed epilepsy.
Epilepsy Res.
1999;
37
81-87
8
Frank L M, Enlow T, Holmes G L. et al .
Lamictal (Lamotrigine) monotherapy for typical absence seizures in children.
Epilepsia.
1999;
40
973-979
9
Gilliam F, Vazquez B, Sackellares J C. et al .
An active-control trial of lamotrigine monotherapy for partial seizures.
Neurology.
1998;
51
1018-1025
10
Jozwiak S, Terczynski A.
Open study evaluating lamotrigine efficacy and safety in add-on treatment and consecutive
monotherapy in patients with carbamazepine- or valproate-resistant epilepsy.
Seizure.
2000;
9
486-492
11
Risner M E, Groenke D A, Womble G A, Messenheimer J A.
Long-term safety and effectiveness of Lamictal® in adults (abstract).
Epilepsia.
1999;
40 (Suppl 7)
140
12
Marson A G, Chadwick D W.
New drug treatments for epilepsy.
J Neurol Neurosurg Psychiatry.
2001;
70
143-147
13
Motte J, Trevathan E, Arvidsson J F. et al .
(Lamictal Lennox-Gastaut Study Group). Lamotrigine for generalized seizures associated
with the Lennox-Gastaut syndrome.
N Engl J Med.
1997;
337
1807-1812
14
Eriksson A S, Nergardh A, Hoppu K.
The efficacy of lamotrigine in children and adolescents with refractory generalized
epilepsy: a randomized, double-blind, crossover study.
Epilepsia.
1998;
39
495-501
15
Beran R G, Berkovic S F, Dunagan F M. et al .
Double-blind, placebo-controlled, crossover study of lamotrigine in treatment-resistant
generalised epilepsy.
Epilepsia.
1998;
39
1329-1333
16
Messenheimer J A, Giorgi L, Risner M E.
The tolerability of lamotrigine in children.
Drug Safety.
2000;
22
303-312
17
Messenheimer J A.
Rash in adult and pediatric patients treated with lamotrigine.
Can J Neurol Sci.
1998;
25
S14-S18
18
Guberman A H, Besag F M, Brodie M J. et al .
Lamotrigine-associated rash: Risk/benefit considerations in adults and children.
Epilepsia.
1999;
40
985-991
19
Roujeau J-C, Kelly J P, Naldi L. et al .
Medication use and the risk of Stevens-Johnson syndrome or toxic epidermal necrolysis.
N Engl J Med.
1995;
333
1600-1607
20
Rzany B, Correia O, Kelly J P. et al .
Risk of Stevens-Johnson syndrome and toxic epidermal necrolysis during first weeks
of antiepileptic therapy: a case control study.
Lancet.
1999;
353
2190-2194
21 Schwere Hautreaktionen unter Lamotrigin-Monotherapie unwahrscheinlich. Satellitensymposium
„Optimierung der Epilepsietherapie” bei der gemeinsamen Jahrestagung der Deutschen,
Österreichischen und Schweizerischen Sektion der Internationalen Liga gegen Epilepsie,
15. - 18. März 2001 in Zürich Beilage. Nervenheilkunde 2001 6: 8
22
Kanner A M, Frey M.
Adding valproate to lamotrigine. A study of their pharmacokinetic interaction.
Neurology.
2000;
55
588-591
23
Sabers A, Buchholz J M, Uldall P, Hansen E L.
Lamotrigine plasma levels reduced by oral contraceptives.
Epilepsy Res.
2001;
47
151-154
24 Lamictal Produkt Information,. Glaxo Wellcome 1999
25
Besag F MC, Berry D J, Pool F.
Methsuximide lowers lamotrigine blood levels: a pharmacokinetic antiepileptic drug
interaction.
Epilepsia.
2000;
41
624-627
26
Holmes L B, Harvey E A, Coull B A. et al .
The teratogenicity of anticonvulsant drugs.
N Engl J Med.
2001;
344
1132-1138
27
Devinsky O, Vuong A, Hammer A, Barrett P S.
Stable weight during lamotrigine therapy: A review of 32 studies.
Neurology.
2000;
54
973-975
28
Edwards K R, Sackellares J C, Vuong A. et al .
Lamotrigine monotherapy improves depressive symptoms in epilepsy: A double-blind comparison
with valproate.
Epilepsy & Behaviour.
2001;
2
28-36
29
Relling M V, Pui C-H, Sandlund J T. et al .
Adverse effect of anticonvulsants on efficacy of chemotherapy for acute lymphoblastic
leucaemia.
Lancet.
2000;
356
285-290
Prof. Dr. med. Dieter Schmidt
Arbeitsgruppe Epilepsieforschung
Goethestraße 5
14163 Berlin
eMail: dbschmidt@t-online.de