Lamotrigine

INTRODUCTION

Indications

Adjunct treatment of partial seizures in adults with epilepsy. Lennox-Gastaut syndrome. Primary generalized tonic-clonic seizures in adults and children ≥2 yr. Conversion to monotherapy in adults with partial seizures receiving a single enzyme-inducing antiepileptic drug. Maintenance treatment of bipolar disorder.

Action

Stabilizes neuronal membranes by inhibiting sodium transport. Therapeutic Effects: Decreased incidence of seizures. Delayed time to recurrence of mood episodes.

Adverse Reactions/Side Effects

CNS: ataxia, dizziness, headache, behavior changes, depression, drowsiness, insomnia, tremor. EENT: blurred vision, double vision, rhinitis. GI: nausea, vomiting. GU: vaginitis. Derm: photosensitivity, rash (higher incidence in children, patients taking valproic acid (VPA), high initial doses, or rapid dose increases). MS: arthralgia. Misc: allergic or hypersensitivity reactions including Stevens-Johnson syndrome.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of allergic and hypersensitivity reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Be especially alert for severe skin reactions (exfoliation, dermatitis) that might indicate Stevens-Johnson syndrome. Notify physician immediately if these reactions occur.

• Document the number, duration, and severity of seizures to help determine if this drug is effective in reducing seizure activity.

• If treating bipolar disorder, monitor any changes in the patient's mood or behavior. Report manic symptoms (excitement, agitation) or symptoms of depression (sadness, apathy, loss of energy).

• Assess dizziness, ataxia, or tremor that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

• Monitor daytime drowsiness, depression, or other changes in behavior. Repeated or excessive symptoms may require change in dose or medication.

• Assess any joint pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug-induced rather than caused by anatomic or biomechanical problems.

Interventions

• Guard against falls and trauma (hip fractures, head injury, and so forth), especially if dizziness or ataxia affect gait and balance. Implement fall-prevention strategies, especially if balance is impaired (See Appendix E).

• Causes photosensitivity; use care if administering UV treatments. Advise patient to avoid direct sunlight and use sunscreens and protective clothing.

Patient/Client-Related Instruction

• Advise patient to avoid alcohol and other CNS depressants because of the increased risk of sedation and adverse effects.

• Advise patients on prolonged antiseizure therapy not to discontinue medication without consulting their physician. Abrupt withdrawal may cause increased seizures.

• Advise patient about the risk of daytime drowsiness and decreased attention and mental focus. Use care if driving or in other activities that require strong ...