Can Lamictal (lamotrigine) cause hyperkinesia with involuntary movements of the buccal region as a

Fråga: Can Lamictal (lamotrigine) cause hyperkinesia with involuntary movements of the buccal region as a side effect? A female patient born 1944 is being examined in the neurology department for a possible mitochondrial metabolic disease. Treatment with Lamictal 50 mg 2x2 was started in November 1995 because of epileptic seizures. The patient has also been treated with Lergigan 25 mg 1-2 in the evenings because of psychiatric symptomatology, as well as with Ismo, Zyloric, Cardizem, Ketogan and Liothyronin. About two days ago the patient developed involuntary movements in the buccal region. The involuntary movements continue despite discontinuation of Lergigan treatment.

Sammanfattning: With the exception of nine reports of hyperkinesia in the WHO side effect register, there is no documentation on hyperkinesias or involuntary movements as a side effect of lamotrigine. Although we cannot see any mechanistic reason for this suspected side effect a cause effect relationship cannot be excluded.

Svar: No reported cases of dyskinesia or hyperkinesia associated with the use of lamotrigine have been found in the literature. The only movement disorders reported for lamotrigine are three cases of disabling tremor after combination of lamotrigine with sodium valproate (1) and one case of ataxia as a part of a multiple system adverse reaction including rash, renal failure, rhabdomyolysis and DIC (2). The Swedish Adverse Drug Reactions Advisory Committee has received one case report with a possible connection to lamotrigine treatment. The WHO side effect register however, contains nine reports of hyperkinesia associated with lamotrigine treatment. In most of these cases, the patient also received other antiepileptic drugs.

We recommend that this case is referred to the Swedish Adverse Drug Reaction Advisory Committee.