Lamictal (lamotrigine) is an anticonvulsant by GlaxoSmithKline approved by the U.S. Food and Drug Administration for the treatment of partial-onset seizures, generalized tonic-clonic seizures, and seizures associated with Lennox-Gastaut syndrome, in patients ages 2 and older.
Lamictal can also be used to treat seizures in Batten disease, usually in combination with another anticonvulsant such as valproate.
How Lamictal works
Batten disease, also called neuronal ceroid lipofuscinosis, is a disorder caused by defects in the processing of cellular waste. This leads to a buildup of these wastes, a mixture of fat and protein called lipofuscin, inside cells causing their death. Nerve cells are particularly vulnerable to lipofuscin accumulation so a major symptom of Batten disease is brain damage and seizures.
Lamictal is chemically unrelated to other anti-epileptic treatments. The medicine’s mechanism of action is not fully understood, but it is known to have several functions thought to contribute to its capacity as an anticonvulsant. In nerve cells, it binds to a sodium channel, preventing it from opening as it normally would when a nerve signal is sent. This binding also suppresses the release of a signaling molecule called glutamate. Together, these two mechanisms are thought to dampen nerve signaling in the brain, reducing the severity and frequency of seizures.
Lamictal also binds and weakly inhibits several other signaling receptors in the brain, including those to which dopamine and serotonin normally bind. By inhibiting these receptors, signaling in the brain is “tuned down,” or reduced, which can also decrease seizure activity.
Lamictal in clinical trials
A study published in the journal Epilepsia evaluated the effects of Lamictal therapy on seizures in 28 patients with juvenile Batten disease. Patients were divided into four groups: one that received Lamictal on an add-on basis; another that received Lamictal as the first treatment for seizure activity; a third that received Lamictal because of epilepsy-like brain activity as determined by polysomnography, a type of sleep study; and a fourth group that was put on Lamictal as a replacement therapy after having adverse reactions to valproate.
After one year, Lamictal showed positive effects in 23 patients. A decrease in seizure frequency was observed in 10 patients, and a decrease in seizure severity in nine of the 22 patients who had seizures prior to the start of the therapy. A total of 18 patients indicated an increase in well-being.
Other information
Lamictal can cause side effects, including skin rash, nausea, vomiting, headache, fatigue, and sleep disturbances. The combination of Lamictal and valproate may also cause tremors.
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