Of the patients with right TLE, 30.8% had ipsilateral
hypometabolism in the epileptic temporal lobe,
11.5% had bitemporal hypometabolism, and 23.1%
had mesial temporal sclerosis. Of the patients with left
TLE, 20.8% had ipsilateral hypometabolism in the
epileptic temporal lobe, 8.3% had bitemporal hypometabolism,
and 37.5% had mesial temporal sclerosis.
The authors concluded that the relative increase in
glucose metabolism contralateral to the epileptogenic
temporal lobe shows that compensatory changes in
the more normal hemisphere may develop.
LAMOTRIGINE SHOWN TO BE MOST EFFECTIVE TREATMENT
FOR PARTIAL-ONSET SEIZURES. Lamotrigine should be
considered the treatment of choice for patients with
partial-onset seizures, according to results of the Standard
and New Antiepileptic Drugs trial, led by Anthony
Marson, MD, senior lecturer in neurology at the
University of Liverpool, United Kingdom.
While carbamazepine is the most widely accepted
treatment for patients with partial-onset seizures, the
researchers concluded that lamotrigine has similar
long-term effectiveness and is better tolerated.
Adults and children in the unblinded, randomized
controlled trial who had been originally treated with
carbamazepine were randomly assigned to receive carbamazepine,
gabapentin, lamotrigine, oxcarbazepine,
or topiramate. At the start of the trial, 87% of patients
were classified as having symptomatic or cryptogenic
partial epilepsy. Outcomes were time to treatment failure
and time to 1-year remission.
Researchers found that in the time-to-treatmentfailure
group, lamotrigine was significantly superior
to the other treatments. In the time-to-1-year-remission
group, gabapentin was significantly inferior to
carbamazepine, lamotrigine, and oxcarbazepine. In
this group, there was no significant difference between
carbamazepine and lamotrigine.
WOMEN’S ISSUES IN EPILEPSY
IN UTERO VALPROATE USE MAY HINDER CHILDREN’S
MENTAL DEVELOPMENT. Valproate poses a greater risk
for behavioral teratogenesis in the unborn child than
do other antiepileptic drugs (AEDs), according to research
by Kimford J. Meador, MD, professor of neurology
at the University of Florida, Gainesville, and
colleagues. The results of this study, conducted by the
Neurodevelopmental Effects of Antiepileptic Drugs
(NEAD) study group, were based on observations of
2-year-old children of women with epilepsy who had
been on monotherapy with carbamazepine, lamotrigine,
phenytoin, or valproate while pregnant.
The interim results of the NEAD study, which will
monitor the neurologic development of the study participants
until they are 6 years old, showed that of the
166 children tested, mean Mental Development Index
(MDI) scores were 94 for children exposed to carbamazepine
in utero, 97 for lamotrigine, 90 for phenytoin,
and 85 for valproate. The percentages of children
with an MDI score lower than 70 for each AED were
12% for carbamazepine, 11% for lamotrigine, 13% for
phenytoin, and 25% for valproate.
The authors said that these findings are supported
by previous studies that have shown that exposure in
utero to valproate is more likely to impair cognitive
development than are other commonly used AEDs.
