Systematic review of efficacy and safety of lamotrigine in the treatment of juvenile myoclonic epilepsy

Abstract

Objective To evaluate the efficacy and safety of lamotrigine in the treatment of juvenile myoclonic epilepsy (JME). Methods Retrieve relevant clinical guidelines, systematic review (including Meta-analysis), randomized controlled clinical trials, case-control studies, retrospective cohort studies and case observation studies on lamotrigine treating JME from online databases (January 1, 1980-December 31, 2017) as PubMed, EBMASE/SCOPUS and Cochrane Library with key words: juvenile myoclonic epilepsy, idiopathic generalized epilepsies, lamotrigine, antiepileptic drugs, random. Jadad Scale, Cochrane System Evaluation Handbook and RevMan 5.3 statistical software were used for quality assessment and Meta-analysis. Results The research enrolled 1220 articles, from which 6 studies with Jadad score ≥ 4 (4 randomized controlled clinical trials and 2 case observation studies) were chosen after excluding duplicates and those not meeting the inclusion criteria. A total of 314 JME patients (166 cases treated by lamotrigine and 148 cases treated by valproate) were enrolled in 6 studies. Meta-analysis showed the occurrence rate of adverse reaction in lamotrigine group was significantly lower than that in valproate group (RR = 0.540, 95% CI: 0.320-0.910; P = 0.020), but there was no significant difference on rate of epileptic seizures decreasing > 50% (RR = 1.200, 95% CI: 0.870-1.650; P = 0.260). Conclusions Lamotrigine is safe and effective in the treatment of JME. It has better tolerance and less adverse reaction, and its effect is similar to that of valproate. It is the first choice for patients with JME, especially foradolescent female patients with JME. However, there is still lack of high-quality trials to confirm whether the combination with other drugs has any benefit in terms of efficacy.

DOI: 10.3969/j.issn.1672-6731.2018.10.010