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Topic Title: lamictal vs. keppra
Topic Summary: pros and cons
Created On: 06/14/2008 11:59 AM
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 06/14/2008 11:59 AM
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My dd currently takes Zarontin for her absence sz, but depending on the results on her next EEG, the neuro may switch her. He's giving me the choice between lamictal and keppra. He explained the lamictal rash and the keppra "rage". He said there could be issues with keppra once she gets to child bearing age, she's only 6 now. I'm leaning toward the lamictal but wanted some feedback first. Any thoughts?

Ilyse, mom to 3 children. Kylie, 7, Ethan, 3, and Sarah, our angel in heaven. Kylie was dx with Absence (6/06). Tried Zarontin, and Keppra. Failed both. Tried Keppra and Lamictal together, now just trying Lamictal. Keeping fingers crossed daily!
 06/14/2008 12:16 PM
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My son has been on both Lamictal and Keppra . Lamictal seemed to be working the first couple of weeks, but every time we titrated, he got a rash. We were only at 12 1/2 mgs (on our way to 75mgs) when we had to take him to the ER with the rash all over his body. ER doc told us discontinue because of danger of SJS. So we did and the rash went away completely in a day or two. Also Nick had trouble sleeping on Lamictal. But I also know there are a lot of kids on here who are doing great on Lamictal.

As far as Keppra goes, we have great sz control with it at lower doses. If we raise his dose over 2ml 2 times a day, we have lots of rage and behavior problems and it also increases sz activity (had to find all this out the hard way). But as most people on here will tell you, every kid is different so the only way to know which one is best for your dd is just to try one. I personally prefer for Nick to be on Keppra.

Hope this helps you. Good luck.


Mom to 4 yr-old energetic boy ~Nick~ Complex partial & Simple Partial szs Dx Cryptogenic E.
Meds: Keppra 2 ml 2x a day Prevacid 30mg. Failed Lamictal (rash). Diastat as needed.

2 abnormal EEGs 1 normal MRI and 1 normal CT.

Cast your burden on the LORD and He shall sustain you; He shall never permit the righteous to be moved. PSALM 55:22
 06/14/2008 03:28 PM
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Keppra has some pro's in that it is very fast to titrate ( go up on) this medication. It does have a bad reputation for behavioral issues, but not everyone has them. Some find that adding Vitamin B6 can help (not all neurologists believe in this because not enough double blinded studies have been done on this so they are all anecdotal, but you read there many kids have been helped with B6)

It IS a true ant-epileptic medication rather than an anti-convulsant medication which many of the older medications are. Lamictal is also an anti-epileptic med so they are on an even plain there....

The half life is about 7 hours.

It can be used as mono-therapy

(Keppra was a bad medication for my son after a certain point. intitially we saw some control on polytheray, then had lost control and say psych issues and NO control.....we stuck it out for 6 months... you do NOT know what works for you unless you try it...My best advice. Working with your doctor. If you see side effects, talking it through with your doctor. You just never know what medications will work for your child.

Lamictal takes a LONG time to get to therapeutic dose (like 12 weeks!) so this is a DOWN side. SOmetimes you do see partial control start before this, however.
The rash risk is there, but it is GREATLY reduced by the SLOW titration, so, you watch for it, stop the medication at the first sign of a rash and get her checked. ( by the way, SAME rash risk exists with DIMETAP, Tegretol, and many COUGH medication, it is just not ADVERTIZED!!)

Lamictal is also a mood stabilizer for some.

The sleep issue does exist. We went through this with Sam. It did p***** but it seemed like a LONG TOUGH ROAD!! We are glad we had the 18 months on this medication. It stopped working after that time and he needed to get off this one as well. For that time it was once of the better ones

It did increase Sam's ADHD Symptoms at higher doses, but not at 400mg which was the dose Sam could tolerate.


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 06/14/2008 04:19 PM
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My dd has also been on both AEDs, although she was on Lamictal for a longer time period.

She has right posterior temporal lobe E, and both Lamictal and Keppra were good drugs for her.

Pros and Cons...hmmm.

Lamictal never seemed to give as good control for her, it was slow to titrate up to effective dose, insomnia, acne, increase in focal 'twitches and jerks", lots of interaction with birth control, BUT GREAT improvement in cognitive functioning, kind of a speeding up in mental processing which was VERY GOOD in her case.

Keppra was our wonder drug and eliminated headaches the first couple of months, easy to increase, no med interactions, no insomnia, no mood problems up to 1500mg daily but we possibly saw some depression over that, MUCH better sz control for my dd.

They are both very good AEDs. Do you think Kylie's diagnosis might change after this EEG? I am not sure which of the two drugs might be more effectice against pure absence sz. Also, I have not heard Keppra could be a problem during pregnancy, but I have heard Lamictal can really interact with changing hormones.

Good luck with your decision! I sure wish there was some way to know in advance how each particular AED would affect your own child...


Mom to 20 yr old dd with onset of bad headaches at age 10...then dx 4-'00 with complex-partial seizures: TLE? Trileptal 1800. 2nd epi, NEW dx 7/05 = IGE, JME?? Trileptal GONE, Lamictal 600, Topamax 125. NLD 3rd epi, dx=rt hemisphere focus? Keppra + Topamax; NOW VEEG 6-'08=Final dx of right posterior temporal lobe E, Keppra gone--currently, 300 mg TOPAMAX MONOTHERAPY ROCKS!! ...most of the time...
 06/14/2008 10:29 PM
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My son started Keppra at 2 years of age. He weaned off it at age 6, it never controlled his seizures, and he had terrible meltdowns that you cannot image. He was always the quiet sweet little boy I could take anywhere, till keppra! Take the worst temper tantrum you have even seen in public from a child and I would say that poor child must be on keppra-it's that bad! As for the developmental side effects of keppra....I didn't realize how severe they were until it was weaned....his teacher said she had never withness a child learn so much so quickly...

As for lamactil, we tried that too, for 1 1/2 years, then the doc tried to tritate up and he got the rash...looking back, I would try lamictal over the keppra any time!

As for seizure control with either medicine, I couldn't tell a difference between either one of them...he was always seizing and in status.

Good luck with your decision!

Laura~Mom of Luke, 7 years old, Doose Syndrome. Currently taking Felbatol. Tried many medications including the ketogenic diet. Thanks to God, he has been seizure free since 4-14-06! Abigail, 10 years old, benign rolandic epilepsy, taking tripeltal, waiting patiently (sigh) for seizure freedom.
 06/14/2008 10:40 PM
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although i didn't have any control on either, i would probably recommend lamictal first. coincidentally, i did have both "the rash" and "keppragge", but the rash seems to be much less common. hope you find a combo that works for you!

horses aren't my whole life, but they make my life whole!

lamictal, depekote er, and keppra failed w/ lots of side effects. no more paxil! but on zoloft. trying to convince all my docs that anti-anxiety drugs aren't going to do anything else...
 06/14/2008 11:05 PM
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When I gave up on Trileptal, my epi actually gave me the same choice, Lamictal or Keppra. I chose Lamictal purely for its side effect profile--Lamictal often causes insomnia, whereas Keppra is *****ociated more with drowsiness (I think this is more common in teens/adults than kids, judging from what people here have reported). He agreed with my decision, although not exactly for the same reasons. He was thinking of the pregnancy issue, too (I'm 23; I was 19ish at the time). While the FDA has not officially stated that Lamictal is safe during pregnancy--it's Category C, "safety during pregnancy has not been demonstrated"--it is generally considered the current safest option. Hopefully there will be major advances in epilepsy treatment by the time your daughter gets anywhere near childbearing age. :o)

But as for me, Lamictal has been my absolute wonder drug. With a little bit of Topamax just for fun, I have probably 99% control and very, very tolerable side effects. The most noticeable one is insomnia. I don't have it all the time, however--I tend to go through random spurts of it that don't seem to be connected to anything else in my life, not hormones, weight, stress, degree of George Clooney obsession...nothing.

I have a few other side effects as well, which also seem to go in cycles--completely unrelated to each other. They include:
--Headaches (miserable, but brief)
--Nausea (completely eliminated if I take Lamictal with sufficient food)
--Acne (not so much an issue for your daughter)
--Double vision/trouble walking straight for a short time after a dose (much more common in the beginning; happily rare now)

The only other thing to watch for with Lamictal (besides the rash) is that the pills aren't coated, and it is a FOUL-tasting drug. :P So it becomes very important not to "miss," if you know what I mean.

But as I said, Lamictal has been and continues to be amazing for me, and I will bow down to its hexagon-shaped altar.

Proud captain of the Battlestar Epileptica
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"You should see the way my brain works sometimes." "You have a brain?" (Battlestar Galactica)
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 06/15/2008 09:54 AM
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My dd has been on both. Both have worked well for her for quite some time.

Lamictal...had quite a bit of trouble focusing on Lamictal, and was troubled by headaches and insomnia, also some nausea on occasion, but we really became Lamictal Fan Club members for the most part, so much so she was picked for an ad campaign, but then the lawyers got skittish when they realized that she was not 16 yet, and it had not been approved for those under 16 at the time...(she was on it from 10-15)

Keppra....she is on this now, and we feel her cognitive functioning is a bit better on this, as compared to Lamictal...yes, yes, I know that Lamictal is considered to be excellent in the 'cognitive sparing' category, but while she is more tired on Keppra, I feel that her cognitive fx is a bit better. Her periods are a bit messed up, but I am not sure if that is the Keppra or just her.

I have met many babies born to moms on Lamictal, and have not seen any kind of birth defects in those children. Not to say there aren't some....but not from my anecdotal experience. I don't know anyone who has concieved on Keppra.

mom to 19y daughter-TLE partial seizures since '98. Keppra, folic acid, elavil. Off to college!!

God.... the one who so wonderfully comforts and strengthens us in our hardships and trials. And why does he do this? So that when others are troubled, needing our sympathy and encouragement, we can p*a*s*s on to them this same help and comfort God has given us.
(2 Cor. 1:3–4 TLB)
 06/16/2008 09:56 PM
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Hi Ilyse, We had great results on Keppra for about 6 weeks. Complete control. Not a lot of "raginess" that we could say was purely Keppra or 9yo boy moodiness so we did add 50mg of B6 and that seemed to level him out. We had our boy back. We stopped when he began breaking through and control was rapidly lost. We're now on day 6 of Lamictal, constantly checking skin from head to toe!! :) He's very tired during the afternoon, but not so much at bedtime. Wondering about insomnia. So far, only side effect we've seen. Keeping our fingers crossed! Hope that helps, Laura
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