Lamotrigine Proves To Be Effective Add-On Therapy
Today, amidst the buzz of epilepsy professionals presenting their latest research at the AES conference, epilepsy.com staff had the chance to talk to Joyce Cramer regarding her latest study. Ms. Cramer is an Associate Research Scientist in the Department of Psychiatry at Yale. The purpose of the study was to explore the use of lamotrigine (LTG) as an adjunctive (add-on) therapy to other antiepileptic drugs (AEDs) and its effect on mood states.
“The study started with 196 patients evaluated at baseline using the Profile of Mood States (POMS) scale and the Quality of Life in Epilepsy-31 (QOLIE-31). 151 patients were evaluated after the addition of lamotrigine to previous therapy using the POMS. The POMS was completed again by 51 patients who had their other AEDs withdrawn, leaving them only on lamotrigine (monotherapy),” said Cramer. Only those patients whose seizures were well controlled were considered for withdrawal to lamotrigine monotherapy.
When asked what the POMS scale specifically measured, Cramer replied, “This scale has a series of questions addressing 6 mood domains including tension, depression, anger, vigor, fatigue and confusion. The domain scores are added to create a total score. Both domain and total scores were used for analyses.” She also noted that POMS is a well- established mood assessment tool.
In terms of the medical implications of this study for people with epilepsy, Cramer contends that, “Lamotrigine appears to improve mood states even when added to other antiepileptic drugs. The improvement likely was not due to synergy, but attributable only to lamotrigine because it remained stable after withdrawal of other AEDs.”
In conclusion Cramer said, “Over the past several years I’ve been trying to get epileptologists to realize the high incidence of mood disorders in the population of people with epilepsy as well as all people with chronic neurological disorders. We should not assume that anxiety and depression are part of the package of having a chronic neurological disorder. These people should and can be helped.”
The study that forms the basis for this interview is fully detailed in:
Cramer JA, Hammer AE, Kustra RP. Improved mood states with lamotrigine in patients with epilepsy. Epilepsy & Behavior, 2004; 5: 702-707.
Additional information can be found in the following reports:
Cramer JA, Blum D, Reed M, Fanning K, for the Epilepsy Impact Project Group. The influence of comorbid depression on quality of life for people with epilepsy. Epilepsy & Behavior 2003; 4: 515-521.Cramer JA, Blum D, Reed M, Fanning K, for the Epilepsy Impact Project Group. The influence of comorbid depression on seizure severity. Epilepsia 2003; 44: 1578-1584.
Cramer JA, Blum D, Fanning K, Reed M, for the Epilepsy Impact Project Group. The impact of comorbid depression on health resource utilization by people with epilepsy. Epilepsy & Behavior, 2004; 5: 337-342.
Ettinger A, Reed M, Cramer J, for the Epilepsy Impact Project Group. Depression and co-morbidity in community-based patients with epilepsy or asthma. Neurology 2004; 63:1008-1014.