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Lamotrigine and levetiracetam exert a similar modulation of TMS‐evoked EEG potentials
Author(s) -
Premoli Isabella,
Biondi Andrea,
Carlesso Sara,
Rivolta Davide,
Richardson Mark P.
Publication year - 2017
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/epi.13599
Subject(s) - levetiracetam , lamotrigine , electroencephalography , transcranial magnetic stimulation , evoked potential , crossover study , medicine , psychology , placebo , epilepsy , neuroscience , anesthesia , pharmacology , stimulation , alternative medicine , pathology
Summary Objective Antiepileptic drug ( AED ) treatment failures may occur because there is insufficient drug in the brain or because of a lack of relevant therapeutic response. Until now it has not been possible to measure these factors. It has been recently shown that the combination of transcranial magnetic stimulation and electroencephalography ( TMS ‐ EEG ) can measure the effects of drugs in healthy volunteers. TMS ‐evoked EEG potentials ( TEP s) comprise a series of positive and negative deflections that can be specifically modulated by drugs with a well‐known mode of action targeting inhibitory neurotransmission. Therefore, we hypothesized that TMS ‐ EEG can detect effects of two widely used AED s, lamotrigine and levetiracetam, in healthy volunteers. Methods Fifteen healthy subjects participated in a pseudo‐randomized, placebo‐controlled, double‐blind, crossover design, using a single oral dose of lamotrigine (300 mg) and levetiracetam (3,000 mg). TEP s were recorded before and 120 min after drug intake, and the effects of drugs on the amplitudes of TEP components were statistically evaluated. Results A nonparametric cluster‐based permutation analysis of TEP amplitudes showed that AED s both increased the amplitude of the negative potential at 45 msec after stimulation (N45) and suppressed the positive peak at 180 msec (P180). This is the first demonstration of AED ‐induced modulation of TMS ‐ EEG measures. Significance Despite the different mechanism of action that lamotrigine and levetiracetam exert at the molecular level, both AED s impact the TMS ‐ EEG response in a similar way. These TMS ‐ EEG fingerprints observed in healthy subjects are candidate predictive markers of treatment response in patients on monotherapy with lamotrigine and levetiracetam.