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To the Editor:
I find it difficult to understand the conclusion of Gilliam et al.1 that “lamotrigine is effective and well tolerated when administered as monotherapy in adult patients with partial seizures.” Monotherapy with high doses of lamotrigine 500 mg was attempted in 76 patients not controlled on phenytoin or carbamazepine. Two thirds (48 patients) were withdrawn because of worsening of the seizures or side effects that occasionally were severe and life threatening. Only 28 patients “successfully completed monotherapy period.” “Successfully” refers to the ability of these patients to tolerate lamotrigine and not to seizure reduction. Thus, whether these 28 patients were better than before lamotrigine treatment, which should be the main objective for this treatment strategy, is immaterial in this study design. That these results were comparable with small doses of sodium valproate does not justify the above conclusion. Leppik’s accompanying editorial2 recommends that “a clinician should have no reservations in using lamotrigine as a monotherapy in the …
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