Case Report

Lamotrigine ODT-Induced Seizure in a 3-Year-Old Child after Accidental Ingestion

Table 1

Case reports of pediatric seizures following lamotrigine ingestion.

ReferenceAge, sexDose, formulaPresentationDrug concentrationManagementOutcome

Present case3-year-old maleUp to 27.6 mg/kg in ODT tabletsAcute: 1 seizure <1 minute in duration within 1 hour with myoclonic activity, dysconjugate gaze, coma23.2 mcg/mL (3-4-hour level) & 18.5 mcg/mL (24-hour level)Lorazepam, intubationDischarged well after 72 hours

Grosso (2016)3.2-year-old male1600 mg total (wt not given)
200 mg tablets
Acute: tonic-clonic status epilepticus upon presentation. After 30 min postictal pattern28.4 mg/L after 10 hours of fluidsRectal diazepam x 2, IVP
midazolam, then cont infusion
Discharged at approx 72 hrs. Hyperphagia still present at discharge

Moore (2013)1-year-old femaleUnknown quantityAcute: initially agitated and crying with intermittent myoclonus of her extremities18 mg/L at 8 h and
11.8 mg/L at 19 h
LorazepamDischarged well after 19 hours

Close (2010)2-year-old maleUp to 43 mg/kg tabletAcute: 2 seizures of 5-second duration within 3 hours with ataxia, drowsiness, nystagmus, hyperreflexia vomitingNot availableDiazepamDischarged well after 12 hours

Thundiyil (2007)19-month-old maleUnknown amount of a chewable tabletAcute: 2 seizures of <10-second duration in 1 hour with irritability, vomiting, sinus tachycardia20.3 mg/L (1-hour level)Activated charcoalDischarged well after 24 hours

Willis (2007)12-day-old maleNot availableAcute: repeated poisoning (including in the hospital); 2 seizures (9 days apart), with arm movements, irritability, poor interaction, poor feeding35 mg/L (2 days after the second seizure)Lorazepam, phenytoin, paraldehyde19-day admission with seizures at days 4 and 13, discharged well to child protection

Lofton (2004)3-year-old femaleNot availableAcute: multiple seizures with vomitingNot availableNot availableNot available

Briassoulis (1998)2-year-old male62 mg/kg tabletAcute: 2 seizures (15- and 5-minute duration) within 90 minutes with muscle weakness and incoordination, ataxia, tremor, hypertonia3.8 mg/L (2-hour level)Midazolam, gastric lavage, activated charcoalDischarged well after 48 hours

Modified from the following: Close BR, Banks CJ: Seizures secondary to lamotrigine toxicity in a two-year-old. Ann Pharmacother 2010;44:1112-5.