Aggressive behaviour in intellectually challenged patients with epilepsy treated with lamotrigine

Purpose: Lamotrigine (LTG) is a valuable addition to the medical management of epilepsy with wide spectrum of efficacy and good outcomes for quality of life. We report the emergence of a syndrome of aggressive behavior provoked by LTG in patients with epilepsy and intellectual challenge. Methods: On recognition of a tendency to aggression in intellectually challenged patients whose epilepsy was treated with LTG, a survey was conducted of those from centers specializing in management of patients with intellectual disability who were treated with LTG. Responses to LTG were sought and patient's behavioral profiles were determined, Results: Nineteen patients were identified (16 men, 3 women, aged 17-54 years). Five patients discontinued LTG due to unprovoked aggressive behavior subsequent to its use; 2 had aggressive behavior sufficient to justify discontinuation of LTG but required reintroduction to control the epilepsy; 1 required reduction in LTG dosage; 1 had aggression that responded to psychiatric intervention; and 1 had aggression unrelated to LTG. Four patients had behavioral problems other than aggression, 4 had no change in behavior, and the behavior of 1 was improved by LTG treatment. Conclusions: LTG may provoke aggressive behavior and violence in intellectually handicapped patients with epilepsy, which may limit its use in such patients. Acknowledgment of the potential for such disturbance justifies greater surveillance of these patients and early discontinuation of LTG if necessary.