Abstracts

Rationale: Falling due to startle-induced seizures (SISs) often leads patients to injury. The triggers of SIS are unexpected visual, somatosensory, or auditory stimuli, which are too common to avoid in daily life. As SISs are often refractory to medication, effective therapeutic option is desired. Methods: We report three patients whose SISs were significantly improved by lamotrigine (LTG), liberating patients from restricted daily life. Follow-up periods ranged from three months to one year. Results: (Patient 1) A 19 year-old male with mild mental retardation. The onset of epilepsy was at seven months. His seizure was sudden tonic extension of the arms and legs induced by unexpected sound, visual or touch stimulus. He fell down due to SIS from five to ten times per day with frequent injury. Interictal EEG showed spikes predominant on left frontal region. Ictal EEG showed bilateral diffuse attenuation. MRI showed mild diffuse cerebral atrophy. SISs decreased to once a month after adding LTG 200mg to VPA and CLB. Seizure reduction made him free from crawling all day. (Patient 2) A 51 year-old female. The onset of epilepsy was at 8 years. Sudden tonic extension of all limbs induced by unexpected sounds frequently struck her down to the floor. Ictal EEG showed bilateral polyspikes over F-C-P area followed by diffuse attenuation. MRI demonstrated mild diffuse cerebral atrophy. Addition of LTG 150mg to CLB, ZNS and PHT reduced her several daily SISs to less than once a day and dramatically improved her life. (Patient 3) A 7 year-old female with post-encephalitic epilepsy. Ictal EEG showed bilateral diffuse polyspikes followed by attenuation. MRI revealed diffuse cerebral atrophy predominantly on bilateral frontal lobes. Her seizures occurred around one hundred times a day. After adjunctive LTG 20mg to VPA, the severity of SISs became milder enough for her to escape injury, although seizure frequency did not decrease. Conclusions: LTG is potentially effective for the treatment of SISs and may prevent falling. LTG should be considered to be an option for SISs.