Paradoxic Reaction to Lamotrigine in a Child with Benign Focal Epilepsy of Childhood with Centrotemporal Spikes

doi:10.1111/j.1528-1157.1999.tb02053.x

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Wiley InterScience

Epilepsia

Volume 40 Issue 11, Pages 1657 - 1660

Published Online: 2 Aug 2005

Published on behalf of the International League Against Epilepsy (ILAE)

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Paradoxic Reaction to Lamotrigine in a Child with Benign Focal Epilepsy of Childhood with Centrotemporal Spikes

Santiago Catania ^† , Helen Cross* ^† , Carlos de Sousa*, Stewart Boyd ^†

*Departments of Paediatric Neurology, Great Ormond Street Hospital for Children NHS Trust, and Neurosciences Unit, Institute of Child Health, University College Medical Schools, London, England ^† Clinical Neurophysiology, Great Ormond Street Hospital for Children NHS Trust, and Neurosciences Unit, Institute of Child Health, University College Medical Schools, London, England

Address correspondence and reprint requests to Dr. S. Boyd at Department of Clinical Neurophysiology, Great Ormond Street Hospital for Children, Great Ormond Street, London WCIN 3JH, U.K. sboyd@ich.ucl.ac.uk

KEYWORDS

Benign focal epilepsy with centrotemporal spikes • Absence seizures • Lamotrigine

ABSTRACT

Summary: A girl aged 5 years developed nocturnal seizures (mouth twitching, salivation, anarthria, with right arm jerking and occasional secondary generalisation), with frequent focal sharp waves over the left centrotemporal region in her EEG, suggesting benign childhood epilepsy with centrotemporal spikes (BECTS). Seizures became diurnal and frequent, not modified by carbamazepine (CBZ) or valproate (VPA) but responding to VPA and lamotrigine (LTG) with recommended dosage schedules for this combination.

Her school performance then deteriorated insidiously, with poor memory and concentration, clumsiness, stuttering, and emotional lability. After 4 months, new episodes, ≥10 per day, occurred. These lasted a few seconds; she stared into space, her jaw dropped, her head dropped to the right, and her eyelids flickered. She usually maintained awareness. Attacks were often provoked by blowing or sneezing. Ictal EEG showed anterior-predominant 3/s sharp-slow wave complexes lasting ≥8 s, with bilateral rolandic discharges interictally. Withdrawal of LTG resulted in rapid improvement in cognitive function and gradual remission of the new attacks.

Conclusions: This appears to be a paradoxic reaction to LTG in the setting of BECTS.

Accepted April 14, 1999

DIGITAL OBJECT IDENTIFIER (DOI)

10.1111/j.1528-1157.1999.tb02053.x About DOI