An audit of lamotrigine use as first-line monotherapy

Lamotrigine is licensed for first-line monotherapy use in the United Kingdom but many physicians have been reluctant to use it because of its perceived increased cost over conventional first-line antiepileptic medication. Clinical trials, however, have suggested that it has equivalent efficacy to conventional drugs in this role, with a significantly reduced side effect profile. It has been the policy of the University Seizure Clinic to use lamotrigine as its first-line drug in all epilepsies for some time. This paper reports an audit of the first 100 cases treated, followed-up for a year from the onset of treatment. A low slow dose escalation policy is utilized. 83% of patients have become seizure-free on the drug: 5% were withdrawn because of side effects and in 12% the drug was withdrawn because of a lack of efficacy. The mean total daily dose needed to develop seizure control is less than 100 mg, meaning that the cost of using this drug in this way is not excessive. Because of the risk of developing a hypersensitivity reaction rapid escalation is avoided but this has the advantage of using the minimum dose necessary to control seizures. As is well known, whatever drug is used first to control epilepsy is likely to succeed: using a drug which is not enzyme-inducing and which does not affect ovarian function in women may be advantageous.