Enfants épileptiques pharmacorésistants et suivi thérapeutique pharmacologique de la lamotrigine

Abstract

INTRODUCTION: Epilepsy is a chronic and disabling pathology which begins, in more than 50% of cases, before the age of 10. Patients who are resistant to AEDs suffer from poor quality of life and socio-professional disintegration. Therapeutic pharmacological monitoring (TDM) of lamotrigine (LMT) in epileptic children is particularly useful in complex situations where it is difficult to assess the response and thus allows to improve the management of epilepsy and improve the quality of life of epileptic children. The aims of this study were to identify drug-resistant children on LMT and to assess demographic, clinical and pharmacokinetic factors associated with drug resistance in these children. METHODS: This retrospective descriptive study was conducted at Clinical Pharmacology (2012-2021). We included children under 18 years old with epilepsy, on LMT, referred for trough plasma level (C0) measurement as part of the TDM of LMT. RESULTS: We included 114 epileptic children prescribed LMT. Drug resistance was reported in 38.6% (n=44) and was higher in boys (73%). LMT C0 were significantly higher in drug resistant epileptic children (4.75 µg/mL versus 8.7 µg/mL, p=0.000). Bioavailability was low in 20.5% of the cases of drug resistant epileptic children. CONCLUSIONS: Drug resistance was observed in 38.6% of epileptic children treated with LMT, the majority of whom were boys. Residual LMT concentrations were higher in drug-resistant epileptic children on LMT.