Beneficial cognitive effect of lamotrigine in severe acquired brain injury: A case report

Abstract

Background: Acquired brain injuries (ABI) can cause various negative sequelae, including cognitive impairment, leading to poor functional outcomes for patients. Evidence is limited on pharmacological interventions to effectively improve the cognitive status of these patients. This study aims to provide evidence for the use of lamotrigine to improve the cognitive status of patients with severe ABI. Case presentation: We report the case of a 29-year-old man who suffered a severe traumatic brain injury secondary to a motor vehicle collision. When admitted to our rehabilitation program three months later, he was in a minimally conscious state, achieving Level III on the Rancho Los Amigos Cognitive Scale. Post-traumatic seizures were well controlled with levetiracetam. Multiple neurostimulants including methylphenidate, amantadine, and venlafaxine were trialed with minimal benefit, thereby prompting the switch of his antiepileptic medication to lamotrigine five months after his injury. The introduction of lamotrigine was followed by relatively rapid and significant improvement in arousal, cognition and communication that preceded levetiracetam being tapered. The patient continued making functional gains over the following year while using lamotrigine. Conclusions: Lamotrigine may potentially provide cognition-enhancing effects independent of its known anti-epileptic properties in patients with severe ABI. Further research is required on the role of lamotrigine in patients with ABI.

Keywords

• Acquired brain injury
• Lamotrigine
• Cognitive impairment
• Rehabilitation
• Functional outcome