Redefining the age-specific therapeutic ranges of lamotrigine for patients with epilepsy: A step towards optimizing treatment and increasing cost-effectiveness

Wang, Minglu; Wang, Huanxin; Zhao, Mingming; Ma, Yiyi; Zhao, Limei

doi:10.1016/j.eplepsyres.2021.106728

Cited by 3 publications

References 57 publications

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The reference range of lamotrigine in the treatment of epilepsy in children: a systematic review

Chen,

Huang,

Zeng

et al. 2023

Eur J Clin Pharmacol

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Purpose This study intends to assess the reference range of lamotrigine concentration for treating childhood epilepsy. Methods PubMed, Ovid-Embase, The Cochrane Library, CNKI, WanFang data and VIP databases were searched from database inception to January 2022. RCT, cohort study, case–control study, cross-sectional study that estimated the reference range of lamotrigine for children epilepsy treatment were included. The data extracted included basic information, statistical methods, data type, and results of reference range. Descriptive analysis was performed for them. Results 8 studies were included and estimated the reference range, and all of them were calculated based on efficacy data and/or concentration data. Statistical methods including ROC curve, concentration-effect curve, mean ± standard deviation, 95% confidence interval and percentile interval were utilized. For lamotrigine monotherapy, the lower limits ranged from 2.06 mg/L to 3.99 mg/L, and the upper limits ranged from 8.43 mg/L to 9.08 mg/L, showing basic consistency. However, for lamotrigine concomitant with valproate, the lower limits ranged from 2.00 mg/L to 8.00 mg/L, and the upper limit was 11.50 mg/L, for lamotrigine concomitant with other antiepileptics, the lower limits ranged from 1.00 mg/L to 3.09 mg/L, and the upper limits varied from 5.90 mg/L to 16.24 mg/L, indicating inconsistency. Conclusion Several studies have estimated the reference range of lamotrigine for childhood epilepsy, while controversy exist and no studies have determined the upper limit of the range based on safety data. To establish the optimal reference range, further high-quality studies are necessary that consider both efficacy and safety data.

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The reference range of lamotrigine in the treatment of epilepsy in children: a systematic review

Chen,

Huang,

Zeng

et al. 2023

Eur J Clin Pharmacol

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Influence of UGT2B7, UGT1A4 and ABCG2 Polymorphisms on the Pharmacokinetics and Therapeutic Efficacy of Lamotrigine in Patients with Epilepsy

Yang,

Wang,

Ning

et al. 2024

Eur J Drug Metab Pharmacokinet

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Treatment Outcomes and MRI Features of SUNA: A Systematic Review and Meta-Analysis

Verma,

Khanduja,

Etienne

2024

Preprint

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Background: Trigeminal autonomic cephalalgias (TACs), including short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA), are rare but debilitating headaches. The pathophysiology and optimal treatment of SUNA remain poorly defined, compounded by disparities in healthcare access. Objectives: To systematically review and analyze the effectiveness of treatment options, clinical outcomes, and brain MRI findings for SUNA, and to identify gaps in the current evidence base. Methodology: Following PRISMA guidelines, a systematic search was performed across multiple databases. Data from 20 studies were analyzed, focusing on treatment efficacy, patient demographics, and MRI findings. Meta-analyses were conducted on treatment effectiveness, and bias was assessed using the Newcastle-Ottawa Scale. Results: Among 267 patients, the most commonly used treatments were lamotrigine (37.07%) and greater occipital nerve (GON) block (16.85%), showing effectiveness in over 50% of cases. Heterogeneity in lamotrigine effectiveness was high (Cochran Q = 63.10, p-value < 0.0001, α = 0.05). Lidocaine was effective for acute attacks (> 80%). Brain MRIs were mostly unremarkable, with some evidence suggesting neurovascular involvement. Conclusion: Lamotrigine and GON block are effective for SUNA, though treatment responses vary widely. MRI findings often lack abnormalities, suggesting a need for further research into the pathophysiology of SUNA. Larger, high-quality studies are needed to establish standardized treatment protocols and improve patient outcomes.

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Redefining the age-specific therapeutic ranges of lamotrigine for patients with epilepsy: A step towards optimizing treatment and increasing cost-effectiveness

Cited by 3 publications

References 57 publications

The reference range of lamotrigine in the treatment of epilepsy in children: a systematic review

The reference range of lamotrigine in the treatment of epilepsy in children: a systematic review

Influence of UGT2B7, UGT1A4 and ABCG2 Polymorphisms on the Pharmacokinetics and Therapeutic Efficacy of Lamotrigine in Patients with Epilepsy

Treatment Outcomes and MRI Features of SUNA: A Systematic Review and Meta-Analysis

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