Lamotrigine Induces Tremor among Epilepsy Patients Probably via Cerebellar Pathways

Andrea Kovács, Zsuzsanna Farkas, A. Kelemen, Vera Juhos, A. Szűcs, A. Kamondi

Research output: Article

Abstract

Lamotrigine, a frequently used antiepileptic drug, inhibits voltage-gated sodium-channels. By suppressing the release of glutamate and aspartate, lamotrigine acts as a membrane stabilizer, and it is also effective in bipolar disorder and migraine. However, lamotrigine is known to induce tremor among 4-10% of patients. We examined the lamotrigine-induced tremor in 28 epilepsy patients (age: 38.06 ± 13.56 years; 24 females and 4 males) receiving lamotrigine monotherapy and compared the data to 30 age- and sex-matched controls (age: 33.06 ± 10.71 years; 25 females and 5 males). Tremor was visually assessed by clinical tremor rating scales. Quantitative characteristics (intensity, center frequency and frequency dispersion) which are regularly used to differentiate various tremor syndromes were measured by validated, sensitive biaxial accelerometry in resting, postural and intentional positions. Regularity of repetitive finger and hand movements and reaction time were also determined. Data were statistically analyzed. Clinical tremor rating scales detected pathological tremor in three patients (10%), while accelerometry revealed tremor in seven patients (25%). Center frequency of patients with pathological tremor was similar to controls, but the frequency dispersion was significantly lower and tremor intensity was significantly higher in both postural and intentional positions. Rhythmic movements and reaction time were normal. Our results show that objective measurements detect pathological intention tremor in 25% of epilepsy patients receiving lamotrigine monotherapy. Quantitative characteristics suggest the involvement of the cerebellum in the pathomechanism of lamotrigine-induced tremor. Determining the parameters of drug-induced tremor syndromes might help to understand the complex action of tremor generator networks.

Original languageEnglish
Pages (from-to)273-284
Number of pages12
JournalThe Tohoku journal of experimental medicine
Volume248
Issue number4
DOIs
Publication statusPublished - jan. 1 2019

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Tremor
Epilepsy
Accelerometry
Voltage-Gated Sodium Channels
lamotrigine
Aspartic Acid
Anticonvulsants
Glutamic Acid
Membranes
Migraine Disorders
Bipolar Disorder
Pharmaceutical Preparations
Cerebellum
Fingers
Hand

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)

Cite this

Lamotrigine Induces Tremor among Epilepsy Patients Probably via Cerebellar Pathways. / Kovács, Andrea; Farkas, Zsuzsanna; Kelemen, A.; Juhos, Vera; Szűcs, A.; Kamondi, A.

In: The Tohoku journal of experimental medicine, Vol. 248, No. 4, 01.01.2019, p. 273-284.

Research output: Article

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