Effect of Lamotrigine on Refractory Epilepsy: Clinical Outcomes and EEG Changes.

Abstract

Background: Refractory epilepsy poses significant challenges in clinical management due to its resistance to standard antiepileptic therapies, necessitating the exploration of more effective treatment regimens. Lamotrigine, with its proven efficacy and tolerability, offers potential benefits when combined with traditional medications like valproate, though its comprehensive impact on clinical outcomes and neurological markers requires further study.

Objective: To analyze the improvement effect of combined application of lamotrigine on refractory epilepsy patients and its impact on patients' EEG and neurological function.

Methods: This retrospective cohort study analyzed the clinical data of 93 patients with refractory epilepsy who were admitted to our hospital between January 2023 and June 2024. Based on the treatment interventions received, patients were divided into a control group (n=46, treated with valproate) and an observation group (n=47, treated with lamotrigine in addition to valproate). The clinical treatment effects, EEG (δ, θ, α, β) power levels, neurological function indicators [brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF), pro-apoptotic protein Bcl-2, Bax], inflammatory response indicators [interleukin-1β (IL-1β), interleukin-6 (IL-6), prostaglandin E2 (PGE2)], and the incidence of adverse reactions were compared between the two groups.

Results: The clinical treatment effect in the observation group was significantly better than that in the control group, with a higher total effective rate (93.62% vs 76.09%, P<0.05). The monthly seizure frequency was significantly reduced in both groups after treatment (P < 0.05). The observation group demonstrated a significantly greater reduction in seizure frequency compared to the control group (P = 0.014). Regarding EEG power levels, both groups showed decreases in δ and θ power levels and increases in α and β power levels after treatment, with the observation group exhibiting more pronounced changes (P<0.05). Neurological function indicators revealed that Bcl-2 levels decreased, while BDNF, NGF, and Bax levels increased in both groups after treatment, with the observation group showing more significant improvements (P<0.05). Similarly, inflammatory response indicators, including IL-1β, IL-6, and PGE2, decreased in both groups, with the observation group demonstrating greater reductions (P<0.05). The incidence of adverse reactions was comparable between the two groups, with no significant difference observed (23.40% vs 17.39%, P>0.05).

Conclusion: Compared to valproate treatment alone, the combined application of lamotrigine can further enhance the efficacy in refractory epilepsy patients, Lower the seizure frequency, improve EEG power levels and neurological function, reduce inflammatory responses, and does not increase the risk of related adverse reactions.