Effects of lamotrigine on nocturnal sleep, daytime somnolence and cognitive function in focal epilepsy Placidi F, Marciani MG, Diomedi M, Scalise A, Pauri F, Giacomini P, Gigli GL. Effects of lamotrigine on nocturnal sleep, daytime somnolence and cognitive functions in focal epilepsy. Acta Neurol Scand 2000: 102: 81±86. # Munksgaard 2000. Objectives ± The aim of our study was to evaluate possible changes in nocturnal sleep, daytime somnolence and cognitive functions induced by add-on therapy with lamotrigine (LTG). Material and methods ± Thirteen patients affected by seizures resistant to common antiepileptic drugs (AEDs) underwent nocturnal polysomnographic monitorings, daytime somnolence evaluations and a neuropsychological battery before and after 3 months of treatment with LTG. Results ± With LTG therapy we observed a signi®cant increase in REM sleep and a signi®cant reduction in the number of entries into REM and stage shifts. No signi®cant correlation was observed between the decrease in nocturnal epileptiform activity and the increase in REM sleep. Other sleep parameters were unmodi®ed. No signi®cant changes were observed in daytime somnolence and in cognitive performances. Conclusion ± LTG may produce positive effects on epileptic seizures and interictal abnormalities without interfering negatively on REM sleep, with improvement of sleep stability and without changes in daytime somnolence and neuropsychological performances. For these reasons it could be an important drug for improving epileptic patients' quality of life. F. Placidi 1 , M. G.Marciani 1,2 , M. Diomedi 1 , A. Scalise 1,2 , F. Pauri 3 , P. Giacomini 4 , G. L. Gigli 5 1 Clinica Neurologica Universita ÁTor Vergata, 2 IRCCS Clinica S. Lucia Roma, 3 A.F.a.R. Fatebenefratelli, Isola Tiberina, Roma; 4 Clinica Neurologica, Universita Ádegli Studi diRoma La Sapienza, 5 Divisione Neurologica, Ospedale S. Maria della Misericordia, Udine, Italy Key words: lamotrigine; sleep;daytime somnolence; epilepsy Dr Fabio Placidi, Clinica Neurologica, Dipartimento di Neuroscienze, Universita ÁdiRoma Tor Vergata, Via O. Raimondo 8, 00173 Roma, Italy Tel.:++39±6-5914436 Fax: ++39±6-5922086 e-mail: fbplacidi@libero.it Accepted for publication April 6,2000 Lamotrigine[LTG, 3,5-diamino-6-(2,3 dichloro- phenyl)-1,2,4-triazine] is a new antiepileptic drug with an anticonvulsant pro®le similar to that of phenytoinand carbamazepine, but structurally unrelatedto them (1, 2). In fact, the LTG anticonvulsant effectderivesfrom its binding to the inactivated form of the sodium channel with consequent inhibition of sustained repetitive ®ring (3, 4). The drug also potently inhibitsthe pre- synaptic release of glutamate evoked by activation of voltage-dependent sodium channels (5) without acting directly on the N-methyl-D-aspartate recep- tors. LTG has been considered useful in controlling both partial drug-resistant seizures with or without secondary generalization and primary generalized epilepsy with different kinds of seizures (6±8). The effects of this drug on nocturnal sleep and daytime somnolence have not yet been investigated. However, the relationshipbetweensleep and epileptic alterations and between daytime somno- lence and cognitive abilities was studied extensively in the past. In fact, sleep and epilepsy are intimately related (9). The sleep structure is altered by seizures and by interictalepileptic EEG activity in both animals and humans (11). Sleep deprivation and NREM sleep facilitate both interictaland ictal paroxysmal phenomena (12, 13); in particular, sleep instability,exempli®ed by phase shifts, transitions to waking and arousals, increases the frequency of epileptic phenomena (14, 15).On the other hand, the interictal spiking rate and the spatial distribu- tion of interictalEEG abnormalities are reduced during REM sleep (13,16). Besidesexerting an Acta Neurol Scand 2000: 102: 81±86 Printed in UK. All rights reserved Copyright # Munksgaard 2000 ACTA NEUROLOGICA SCANDINAVICA ISSN 0001-6314 81