Seizures and Mood: Gabapentin (Neurontin)

A group of new anticonvulsants can be helpful for adjunctive seizure control and for mood stabilization (Bowley and Kerr 2000). Gabapentin (Neurontin) can be used to augment seizure control, and it works well with valproate or carbamazepine. It has also shown efficacy in augmenting treatment for bipolar disorder and schizoaffective disorder (Bennett et al. 1997; Hellings 1999), so it was considered likely to be helpful in treatment of mood instability in FXS. However, we have not seen beneficial effects in either children or adults with FXS, with only 1 exception in 10 patients treated with gabapentin. Typically, patients have become more irritable, with an increase in outburst behavior at relatively low doses (100-500 mg/day).

Seizures and Mood: Lamotrigine (Lamictal)

Lamotrigine (Lamictal) has been approved to treat partial and secondary generalized seizures, and it inhibits the release of excitatory neurotransmitters such as glutamate and aspartate (Post et al. 1998). Efficacy has been demonstrated in treating bipolar disorder, but 5-10% of patients may experience a maculopapular rash, which can progress to a Stevens-Johnson syndrome (Hellings 1999). Use with valproate can exacerbate this side effect. Dosing in children is 0.5 mg/kg/day for two weeks with a gradual increase to 2-5 mg/kg/day with twice-daily dosing and a careful look at side effects (McElroy and Weller 1997). The adult dosing is 25 mg daily for two weeks, then 25 mg twice a day for two weeks, with a gradual increase if needed to a maximum of 500 mg/day (Hellings 1999).

Seizures and Mood: Topiramate (Topamax), Tiagabine (Gabitril) and Vigabatrin (Sabril)

Topiramate (Topamax), tiagabine (Gabitril), and vigabatrin (Sabril) are three additional new anticonvulsants that also seem to have mood-stabilizing effects and have shown efficacy in seizure control in patients with mental retardation (Bowley and Kerr 2000; Alvarez et al. 1998). However, experience in patients with FXS is limited to the rare patient whose seizures are not well controlled with valproate or carbamazepine.

This article is not intended to give medical advice for individual cases.  Any change in medical treatment should be done in consultation with appropriate medical personnel. This article is written for medical professionals.  Some of the terms will be unfamiliar to those who are not trained in medical fields. *This article is from the chapter on treatment in the 3rd edition of Fragile X Syndrome: Diagnosis, Treatment, and Research edited by Randi Jenssen Hagerman, M.D. and Paul Hagerman, M.D., Ph.D., to be published May 2002.  It is included with permission from The Johns Hopkins University Press. References to other chapters refer to chapters in the book which are not included as part of this website. The complete 3rd edition of Fragile X Syndrome: Diagnosis, Treatment, and Research can be ordered from the National Fragile X Foundation by calling 1-800-688-8765 or from The Johns Hopkins University Press at 1-800-537-5487.

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