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Lamotrigine as a possible cause of QRS prolongation in a patient with known seizure disorder

Published online by Cambridge University Press:  21 May 2015

Thomas J.S. Herold
Thomas J.S. Herold*
Affiliation:
Department of Emergency Medicine, Darnall Army Community Hospital, Fort Hood, Texas
*
Department of Emergency Medicine, Darnall Army Community Hospital, 36000 Darnall Loop, Fort Hood TX 76544-4752; 254 288-8302, fax 254 288-8093, HeroldTJ64@aol.com

Abstract

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Lamotrigine and felbamate are 2 newer anticonvulsant medications used to control refractory partial and generalized seizures. Although several cases of lamotrigine toxicity secondary to acute intentional or unintentional overdose have been described, there is little published information related to potential side-effects associated with the therapeutic use of these agents. Described is a case of a 22-year-old woman who presented to the emergency department after experiencing 2 seizure-like episodes. Findings on evaluation included nystagmus, ataxia, widening of the QRS complex and right-axis deviation on ECG. The patient reported only therapeutic use of her medications. The lamotrigine level was 14.8 mg/L. The mechanism of action for lamotrigine is blockade of the sodium channels; therefore, the patient was treated with intravenous sodium bicarbonate with resultant QRS narrowing following administration.

Keywords

lamotriginefelbamateanticonvulsantscardiotoxicityQRS prolongationtricyclic antidepressant
Type
Case Report • Observations de cas
Information
Canadian Journal of Emergency Medicine , Volume 8 , Issue 5 , September 2006 , pp. 361 - 364
Copyright
Copyright © Canadian Association of Emergency Physicians 2006

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