Question

Lamotrigine is a broad-spectrum antiepileptic. For which of the following seizure types is lamotrigine particularly useful and a recognised first/adjunctive choice?

• A. Generalised tonic-clonic seizures (GTCS)
• B. Myoclonic seizures
• C. Absence seizures
• D. Atonic seizures

Hint:

Broad-spectrum Na-channel blocker; can aggravate myoclonus, but good for GTCS.

Answer 1

The Correct Option is A

Step 1: Recall lamotrigine's mechanism and spectrum.
Lamotrigine blocks voltage-gated sodium channels and inhibits glutamate release. It is a broad-spectrum agent effective in focal seizures, GTCS, and as adjunct in Lennox-Gastaut syndrome.

Step 2: Evaluate each seizure type.
• GTCS: Lamotrigine is effective and is a recognised choice for generalised tonic-clonic seizures.
• Myoclonic: Lamotrigine can aggravate myoclonic seizures (notably in juvenile myoclonic epilepsy), so it is not preferred.
• Absence: Although used, it is less effective than ethosuximide/valproate and may worsen some idiopathic generalised epilepsies.
• Atonic: Atonic/drop attacks are best managed within Lennox-Gastaut regimens; lamotrigine helps as adjunct but GTCS is its clearer indication.

Step 3: Select the best fit.
The seizure type for which lamotrigine is most clearly useful and a first-line generalised indication is GTCS.

Key fact: Lamotrigine is effective for focal seizures and GTCS but can worsen myoclonic seizures.