Use of lamotrigine in impulse control and social cognition in patients with temporal lobe epilepsy
Authors: Mariano Lunizia Mattos , Sousa Guilherme dos Santos , Moraes Lucas Barbosa Napolitano de , Frigo Yasmim Nadime José , Lemos Ana Flavia Andrade , Schelp Arthur Oscar , Betting Luiz Eduardo 
Published: July 2023

Temporal lobe epilepsy (TLE) is a type of focal epilepsy that can begin in one or more regions of the temporal lobe and spread to adjacent brain tissue via neural connections and can be divided into two types according to the Classification of Epileptic Syndromes (ILAE 2017). The most common is mesial temporal lobe epilepsy, which affects temporal regions such as the hippocampus, entorhinal cortex, amygdala, and parahippocampal gyrus. The second type is lateral or neocortical, where seizures occur in the temporal neocortex (superior, medial and inferior temporal, temporooccipital and temporoparietal gyri and associative senses for auditory, visual and verbal functions). Approximately 60% of patients with mesial TLE associated with hippocampal atrophy are unable to control their seizures even after optimal treatment with various antiepileptic drugs. For these patients, epilepsy surgery can be an effective alternative treatment. After a series of preoperative studies, including medical history and careful neurological examination, complex neurophysiological studies (surface, surface and invasive electroencephalographic video electroencephalogram), neuroimaging studies and neuropsychological evaluations for selected cases. Notably, according to Wiebe and Engel, 2012, surgical treatment of TLE is superior to long-term medical therapy in these selected cases. Because the pathophysiological course of mesial TLE may favor preservation of epileptogenesis even after removal of the primary regions, effective cure in these patients is not always guaranteed. Furthermore, due to the location of mesiotemporal lesions, patients with TLE suffer from stigma, associated with seizure and psychiatric disorders, which affects the quality of life and functioning of these patients. Therefore, this study aims to investigate the efficacy of using antiseizure medications, especially lamotrigine on impulse control, which is also impaired in some mood disorders. Bear Fedio Inventory (BFI) was used to study the effect of lamotrigine and other antizeiures medications on impulse control in patients with TLE. Patients with TLE confirmed by clinical semiology and magnetic resonance imaging findings treated with lamotrigine or other antiseizure medications were included. Only patients older than 18 years and younger than 60 years were investigated. Patients with psychotic symptoms were excluded from this analysis. The BFI was used and applied together with the International Personality Disorder Examination (IPDE). All participants received the questionnaires and were allowed to omit any demographic data that they felt might lead to disclosure of their identity. Ethical approval was obtained from the Ethics Committee of the Botucatu Medical School. The inventory consists of 100 items that must be marked as true or false. Each group of five statements examines one of the following areas: writing tendencies, hypermorality, religious beliefs, anger and impatience, tendency to organize or order, decreased libido, fear and anxiety, guilt, seriousness, sadness, emotion, suspicious and detail-oriented, cosmic interest, belief in personal predestination, persistence and reproducibility, hatred and revenge, addiction, euphoria, and somatization. A high score is 2 or more true items in each domain, or 20 or more items marked true in total. The IPDE, on the other hand, describes personality traits according to ICD-10 and identifies them based on a set of 5 responses with at least two being true to assume that the respondent has that trait, such as impulsivity or borderline. 36 respondents answered the questionnaires and the responses were stored and categorized into two groups, those who take lamotrigine medication and those who do not. With this separation in mind, the answers that defined the personality trait according to the inventories were selected and grouped, the answers were yes or no, and the accumulation of the answers and the score of the accumulation were applied, and the positive and negative cases for the trait were grouped so that the chi-square test could be applied. Nine of the 36 respondents were taking lamotrigine and 27 were taking other medications. For the IPED with the score of impulsivity, there were 7 positives and 2 negatives, the 27 who did not use lamotrigine, 21 with a positive score and 6 negatives. For the BFI, the Hate and Vengeance and Euphoria traits were selected for comparison and to test the hypothesis of decreased impulsivity traits. There was no change in the respondents who use lamotrigine, of the 9, only 2 had a positive score and 7 a negative score, for the non-users tested in this criterion 16 positive and 11 negative. There was not difference for hatred and revenge trail between the groups (P = 0.0543). For the euphoria trait, the values for lamotrigine users were 8 positive and 1 negative, and for non-users were 21 positive and 6 negative (P = 0.466). This preliminary investigation did not show difference for impulse control between patients taking lamotrigine or not. A larger sample size is currently underway to support this observation.