The effect of Lamotrigin and Levetiracetam on the perinatal period

Aims: Lamotrigin and Levetiracetam are antikonvulsiva of the new generation. The knowledge about the pharmacokinetics in the perinatal care and during the lactation is of a great importance and hardly studied so far, especially if they are administered in high doses in combination.

Diagnosis, therapy and course: We are reporting on a mature newborn of 41SSW, which was exposed to extremely high doses of maternal anticonvulsant. The mother suffers from epilepsy. Typically at the end of the first trimenon it came to an attack accumulation at her through the increased metabolism of lamotrigine. In the course the dose of levetiracetam was increased dramatically to 2000mg and of lamotrigin to 1000mg per day. Postpartal the boy showed a good adaptation. On the 3rd day of life it came to increased bradycardia with saturation degradation. The diagnosis in the laboratory could exclude an infection. From the 8th day of life the nutrition was changed from breast milk to baby food and from the 10th day of life there were no longer any bradycardia. The drug levels corresponded to the drug levels of the mother. After 72 hours the level of levetiracetam of the child was <10% and of lamotrigin 70% of the values in the cord blood. Because of the increasing drug level of lamotrigin a dose reduction was made post portal. This was initially performed to quickly, so it came to a grand mal seizure again. However, the care of the child by the mother was not possible or only with much support.

Conclusion: Under the treatment with Lamotrigin and Levetiracetam of pregnant there are described side effects at neonates such as increased fatigue and drinking weakness. Under very high dose as in the case of our patient it can probably come to affection for bradycardia at the newborn. However, problems for the newborn may occur by maternal complications. The aftercare should be well organized.