Lamotrigine Hypersensitivity in Childhood Epilepsy

Abstract

Summary: Purpose:To evaluate the effect of lamotrigine (LTG) on several humoral and cellular immune functions in children with epilepsy and the change in immunological status in patients with LTG-induced rash.Methods: Sixteen children with epilepsy of unknown origin or secondary to various etiologies undergoing treatment with LTG participated in the humoral and cellular immunological study. Of these, 2 patients developed a rash during LTG treatment and are described in detail.Results: No modifications of humoral or cellular immunity (measured at 1 and 3 months) were noted in 14 of the 16 patients during this treatment. In the 2 children who manifested rash, basal immune function was normal. In both, immediately after the skin rash appeared, there was a high increase in the percentage of activated T-helper lymphocytes (CDCDR) and activated T-suppressor lymphocytes (CDS-DR), a slight increase in percentage of B lymphocytes (CD19), and a greater increase in serum concentration of IgE. In 1 of the 2 patients, reevaluation of immunity 20 days after the rash appeared and after LTG suspension showed normal percentages of CDCDR, CDS-DR, and CD19, whereas the serum concentration of IgE had decreased.Conclusions: The observed immunological results indicate that LTG-induced rash may be considered an immunemediated hypersensitivity reaction.

Psychogenic Seizures After Head Injury in Children

“…Of the 148 patients who underwent long-term video telemetry, 16 (11%) patients had psychogenic seizures. These children ranged in age from 5 to 18 years, with a mean age of 10.5 years.…”

Lamotrigine

“…LTG-associated skin rash is typically maculopapular or erythematous and displays the characteristics of a delayed hypersensitivity reaction, appearing within the first 4 weeks of initiating treatment and resolving rapidly on treatment withdrawal (38,39). Occasionally the rash may be more severe (erythema multiforme) and may progress to desquamation with involvement of the mucous membranes (Stevens-Johnson syndrome), and possibly to toxic epidermal necrolysis (40,41).…”

Verträglichkeit von Lamotrigin - eine Literaturübersicht

“…Bei über 11 000 Patienten betrug die Inzidenz eines Stevens-JohnsonSyndroms 0,01%, Lamotrigin wurde aufgrund von Exanthemen bei 2% der Patienten abgesetzt [63]. Als ursächlich für die schwer verlaufenden Hautausschläge unter Lamotrigin wurde eine immunologische Lymphozytenreaktion mit Anstieg der T-Helferzellen, der T-Suppressor-Lymphozyten, der B-Lymphozyten und von IgE diskutiert [48,85]. Schwerer erkrankte Patienten weisen über das Exanthem hinaus Lymphknotenschwellungen, rhinitisartige Symptome, Abgeschlagenheit, Muskel-und Gelenkschmerzen, eine Eosinophilie und eine Temperaturerhöhung auf [34,54].…”