Lamotrigine
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Parkinsonism: case report A 48-year-old man developed parkinsonism during treatment with lamotrigine for refractory epilepsy. The man developed progressively increasing tremor in his hands, with a right sided predominance, ever since he started receiving lamotrigine 100mg three times daily, gabapentin and valproic acid [time to reaction onset not clearly stated]. Valproic acid involvement was suspected and its dosage was decreased while the man’s lamotrigine dosage was adjusted to 150mg three times daily. Over the next 6 months, his seizure frequency increased, his tremor became more prominent and he was hospitalised. On admission, he showed clear parkinsonian symptoms. Tremor was present at rest and during postural testing and interfered with goal-directed movements; he showed cogwheel rigidity and bradykinesia. Idiopathic Parkinson’s disease was suspected, valproic acid was stopped and he started receiving levodopa. His symptoms did not improve over the following few weeks. He had a Unified Parkinson’s Disease Rating Scale (UPDRS) Motor score of up to 31. Lamotrigine involvement was then suspected and the drug was discontinued. Clear improvements were noted over the next few days and, 1 month after discontinuation, his UPDRS Motor score was 5; postural tremor, rest tremor, cogwheel rigidity and bradykinesia had resolved while facial hypokinesia and slight general bradykinesia had persisted. The man was rechallenged with a single dose of lamotrigine 200mg. Three hours later, he had a UPDRS Motor score of 19 and his previous signs of parkinsonism recurred. More than 1 year later, he remained free of parkinsonian symptoms despite restarting valproic acid. Author comment: "This case suggests that Parkinsonism can also occur in patients treated with this drug." Santens P, et al. Parkinsonism due to lamotrigine. Movement Disorders 21: 801060148 2269-2270, No. 12, 2006 - Belgium
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Reactions 13 Jan 2007 No. 1134
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